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Zhang J, Hou H, Chen P, Sun B, Hu F, Yu Y, Song L. Mechanical and modal analysis of different implant strategies for loss of three teeth with bone atrophy in the maxillary posterior region. Comput Methods Biomech Biomed Engin 2024:1-10. [PMID: 38829324 DOI: 10.1080/10255842.2024.2358363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE This study aimed to evaluate the stress distribution and secondary stability involved in five implant strategies, including implant-supported prostheses (ISP) and tooth-implant-supported prostheses (TISP), used for bone atrophy in the maxillary posterior region with teeth loss using finite element analysis, and to explore the more desirable implant methods. METHODS Five implant strategies were made to analyze and compare: M1, implant-supported prosthesis consisting of a short implant with a regular implant; M2, implant-supported prosthesis consisting of a tilted implant with a regular implant; M3, cantilever structure; M4, tooth-implant-supported prosthesis consisting of a short implant with a regular implant; M5, tooth-implant-supported prosthesis consisting of a regular implant, and M6, with only the natural teeth as a control group. Dynamic loading of the above models was performed in finite element analysis software to assess the stress distribution of the bone tissue and implants using the von Mise criterion. Finally, the secondary stability of different models was evaluated by modal analysis. RESULTS The maximum stress distribution in the cortical bone in M1(60 MPa) was smaller than that in M2(97 MPa) and M3(101 MPa), The first principal strain minimum was obtained in M2 (2271μ ε ). M4 (33 MPa, 10085 Hz) with the best mechanical properties and highest resonance frequency. But increased the loading on the natural teeth. CONCLUSIONS Short implants and tilted implants are both preferred implant strategies, if cantilever construction is necessary, a tooth-implant-supported prosthesis consisting of a short implant and a regular implant is recommended.
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Affiliation(s)
- Jianguo Zhang
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai, China
| | - Hu Hou
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai, China
| | - Peng Chen
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai, China
| | - Benhao Sun
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai, China
| | - Fengling Hu
- Department of Stomatology, Shanghai Geriatric Medical Center, Shanghai, China
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Youcheng Yu
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Song
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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Shash YH, El-Wakad MT, Eldosoky MAA, Dohiem MM. Finite element analysis of the effect of framework material and thickness on the biomechanical performance of 'All‑on‑Four' full-arch prosthesis. Comput Methods Biomech Biomed Engin 2024:1-16. [PMID: 38756021 DOI: 10.1080/10255842.2024.2355260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
The aim of this research was to evaluate the stress distribution in the 'All-on-Four' prosthesis and the surrounding bone, with different framework materials and thicknesses. Five frameworks (alumina, zirconia, titanium, fiberglass reinforced resin (FRR), and polyether ether ketone (PEEK)) with two thicknesses (3.5 &5.5 mm) were stimulated in this research. A vertical force of 200 N was applied on a 1 mm circular area, at the cantilever, and at the region of the incisors, simulating different mastication mechanisms. The results illustrated that the 5.5 mm framework reduced the stresses on most parts, mucosa, and bone tissues, compared to 3.5 mm.
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Affiliation(s)
- Yomna H Shash
- Department of Biomedical Engineering, Helwan University, Cairo, Egypt
| | - Mohamed T El-Wakad
- Faculty of Engineering &Technology, Future University in Egypt, Cairo, Egypt
| | | | - Mohamed M Dohiem
- Department of Prosthodontics, Zagazig University, Zagazig, Egypt
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Aboelfadl A, Keilig L, Ebeid K, Ahmed MAM, Nouh I, Refaie A, Bourauel C. Biomechanical behavior of implant retained prostheses in the posterior maxilla using different materials: a finite element study. BMC Oral Health 2024; 24:455. [PMID: 38622680 PMCID: PMC11020654 DOI: 10.1186/s12903-024-04142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The aim of this study is to evaluate the biomechanical behavior of the mesial and distal off-axial extensions of implant-retained prostheses in the posterior maxilla with different prosthetic materials using finite element analysis (FEA). METHODS Three dimensional (3D) finite element models with three implant configurations and prosthetic designs (fixed-fixed, mesial cantilever, and distal cantilever) were designed and modelled depending upon cone beam computed tomography (CBCT) images of an intact maxilla of an anonymous patient. Implant prostheses with two materials; Monolithic zirconia (Zr) and polyetherketoneketone (PEKK) were also modeled .The 3D modeling software Mimics Innovation Suite (Mimics 14.0 / 3-matic 7.01; Materialise, Leuven, Belgium) was used. All the models were imported into the FE package Marc/Mentat (ver. 2015; MSC Software, Los Angeles, Calif). Then, individual models were subjected to separate axial loads of 300 N. Von mises stress values were computed for the prostheses, implants, and bone under axial loading. RESULTS The highest von Mises stresses in implant (111.6 MPa) and bone (100.0 MPa) were recorded in distal cantilever model with PEKK material, while the lowest values in implant (48.9 MPa) and bone (19.6 MPa) were displayed in fixed fixed model with zirconia material. The distal cantilever model with zirconia material yielded the most elevated levels of von Mises stresses within the prosthesis (105 MPa), while the least stresses in prosthesis (35.4 MPa) were recorded in fixed fixed models with PEKK material. CONCLUSIONS In the light of this study, the combination of fixed fixed implant prosthesis without cantilever using a rigid zirconia material exhibits better biomechanical behavior and stress distribution around bone and implants. As a prosthetic material, low elastic modulus PEKK transmitted more stress to implants and surrounding bone especially with distal cantilever.
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Affiliation(s)
- Ahmad Aboelfadl
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
- Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany.
| | - Ludger Keilig
- Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany
- Department of Dental Prosthetics, Propaedeutics and Material Science, Dental School, University Hospital Bonn, Bonn, Germany
| | - Kamal Ebeid
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | | | - Ingy Nouh
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ashraf Refaie
- Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany
- Department of Fixed Prosthodontics, Fayoum University, Fayoum, Egypt
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De Giorgis L, Pesce P, Barberis F, Lagazzo A, Pera F, Baldi D, Canullo L, Menini M. Fiber-Reinforced Composites for Full-Arch Implant-Supported Rehabilitations: An In Vitro Study. J Clin Med 2024; 13:2060. [PMID: 38610826 PMCID: PMC11012982 DOI: 10.3390/jcm13072060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Fiber-reinforced composites (FRCs) have been proposed as an alternative to traditional metal alloys for the realization of frameworks in full-arch implant-supported prostheses. The aim of the present in vitro study was to evaluate the deflection under load of seven prostheses endowed with frameworks made of different materials, including different types of fiber-reinforced composites (FRCs). Methods: A master cast with four implant analogues in correspondence with the two lateral incisors and the two first molars was used to create full-arch fixed prostheses with the same shape and different materials. Prostheses were made of the following different materials (framework+veneering material): gold alloy+resin (Au+R), titanium+resin (Ti+R), FRC with multidirectional carbon fibers+resin (ICFRC+AR), FRC with unidirectional carbon fibers+composite (UCFRC+C), FRC with glass fibers+resin (GFRC+AR), FRC with glass fibers+composite (GFRC+C), and resin (R, fully acrylic prosthesis). Flexural tests were conducted using a Zwick/Roell Z 0.5 machine, and the deflection of the lower surface of the prosthesis was measured in order to obtain load/deflection graphs. Results: Greater rigidity and less deflection were recorded for UCFRC+C and GFRC+C, followed by Ti+R and Au+R. The greatest deformations were observed for resin alone, ICFRC+R, and GFRC+R. The results were slightly different in the incisal region, probably due to the greater amount of veneering material in this area. Conclusions: When used to realize full-arch frameworks, Au and Ti allow for predictable mechanical behavior with gradual deformations with increasing load. UCFRC also demonstrated good outcomes and less deflection than ICFRCs when loaded. The GFRC full-arch framework may be a valid alternative, although it showed greater deflections. Further studies are needed in order to evaluate how different prosthesis designs and material thicknesses might affect the outcomes.
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Affiliation(s)
- Luisa De Giorgis
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (L.D.G.); (P.P.); (D.B.); (M.M.)
| | - Paolo Pesce
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (L.D.G.); (P.P.); (D.B.); (M.M.)
| | - Fabrizio Barberis
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Via Opera Pia 15, 16145 Genova, Italy (A.L.)
| | - Alberto Lagazzo
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Via Opera Pia 15, 16145 Genova, Italy (A.L.)
| | - Francesco Pera
- CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Torino, Italy;
| | - Domenico Baldi
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (L.D.G.); (P.P.); (D.B.); (M.M.)
| | - Luigi Canullo
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (L.D.G.); (P.P.); (D.B.); (M.M.)
| | - Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (L.D.G.); (P.P.); (D.B.); (M.M.)
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Tribst JPM, de Jager N, Dal Piva AM, Kleverlaan CJ, Feilzer A. Effect of crown retention systems and loading direction on the stress magnitude of posterior implant-supported restorations: A 3D-FEA. Heliyon 2024; 10:e28129. [PMID: 38515675 PMCID: PMC10956064 DOI: 10.1016/j.heliyon.2024.e28129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
This study aimed to investigate the effect of four retention systems for implant-supported posterior crowns under compressive loading using three-dimensional finite element analysis. A morse-taper dental implant (4.1 × 10 mm) was designed with Computer Aided Design software based on non-uniform rational B-spline surfaces. According to International Organization for Standardization 14,801:2016, the implant was positioned at 3 mm above the crestal level. Then four models were designed with different crown retention systems: screw-retained (A), cement-retained (B), lateral-screw-retained (C), and modified lateral-screw-retained (D). The models were imported to the analysis software and mesh was generated based on the coincident nodes between the juxtaposed lines. For the boundary conditions, two loads (600 N) were applied (axial to the implant fixture and oblique at 30°) totaling 8 conditions according to retention design and loading. The von-Mises stress analysis showed that different retention systems modify the stress magnitude in the implant-supported posterior crown. There is a similar stress pattern in the implant threads. However, models C and D presented higher stress concentrations in the crown margin in comparison with A and B. The oblique loading highly increased the stress magnitude for all models. In the simulated conditions, part of the stress was concentrated at the lateral screw under axial loading for model C and oblique loading for model D. The results indicate a possible new failure origin for crown retained using lateral screws in comparison to conventional cement-retained or screw-retained systems.
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Affiliation(s)
- João Paulo M. Tribst
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Department of Reconstructive Oral Care, Universiteit van Amsterdam en Vrije Universiteit Amsterdam, 1081, LA, Amsterdam, the Netherlands
| | - Niek de Jager
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Dental Materials, Universiteit van Amsterdam en Vrije Universiteit Amsterdam, 1081, LA, Amsterdam, the Netherlands
| | - Amanda M.O. Dal Piva
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Dental Materials, Universiteit van Amsterdam en Vrije Universiteit Amsterdam, 1081, LA, Amsterdam, the Netherlands
| | - Cees J. Kleverlaan
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Department of Reconstructive Oral Care, Universiteit van Amsterdam en Vrije Universiteit Amsterdam, 1081, LA, Amsterdam, the Netherlands
| | - Albert Feilzer
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Dental Materials, Universiteit van Amsterdam en Vrije Universiteit Amsterdam, 1081, LA, Amsterdam, the Netherlands
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Ibrahim CRM, Sameh A, Askar O. A finite element analysis study on different angle correction designs for inclined implants in All-On-Four protocol. BMC Oral Health 2024; 24:331. [PMID: 38481220 PMCID: PMC10938696 DOI: 10.1186/s12903-024-04091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The aim of this study is to investigate, through finite element analysis (FEA), the biomechanical behavior of the built-in angle corrected dental implant versus implant with angled multiunit abutment used in All-On-Four treatment protocol. METHODS Two (3D) finite element models of a simplified edentulous mandible were constructed with two different posterior implant designs based on the All-On-Four protocol. Four implants were placed in each model, the two anterior implants were positioned vertically at the lateral incisor/canine sites. Depending on the implant fixture design in posterior area, there are two models created; Model I; the mandible was rehabilitated with four co-axis (4 mm in diameter × 15 mm in length) implants with distally built-in angle corrected implants (24-degree angle correction) .While Model II, the mandible was rehabilitated with four conventional (4 mm in diameter × 14 mm in length) implants with a distally inclined posterior implants (25 degree) and angled multiunit abutments. CAD software (Solidworks© 2017; Dassault Systems Solidworks Corp) was used to model the desired geometry. Axial and inclined Loads were applied on the two models. A Finite element analysis study was done using an efficient software ANSYS© with specified materials. The resultant equivalent Von-Misses stresses (VMS), maximum principal stresses and deformation analysis were calculated for each part (implants and prosthetic components). RESULTS When applying axial and non-axial forces, model II (angled multiunit model) showed higher deformation on the level of Ti mesh about 13.286 μm and higher VMS 246.68 MPa than model I (angle corrected implant). Model I exhibited higher maximum stresses 107.83 MPa than Model II 94.988 MPa but the difference was not statistically significant. CONCLUSION Within the limitation of the FEA study, although angle correcting implant design is showing higher values in maximum principle stresses compared with angled multiunit abutments, model deformation and resultant VMS increased with angled multiunit abutments. The angle correcting designs at implant level have more promising results in terms of deformation and VMS distribution than angle correction at abutment level.
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Affiliation(s)
| | - Ahmed Sameh
- Production Engineering and Mechanical Design Department, Faculty of Engineering, Mansoura University, Eldakahlia, Egypt
| | - Osama Askar
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Eldakahlia, Egypt
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de Araújo Nobre M, Moura Guedes C, Almeida R, Silva A, Sereno N. The All-on-4 Concept Using Polyetheretherketone (PEEK)-Acrylic Resin Prostheses: Follow-Up Results of the Development Group at 5 Years and the Routine Group at One Year. Biomedicines 2023; 11:3013. [PMID: 38002014 PMCID: PMC10669282 DOI: 10.3390/biomedicines11113013] [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: 09/30/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND It is necessary to investigate the application of polymer materials in implant dentistry. The aim of this study was to examine the outcome of full-arch polyetheretherketone (PEEK)-acrylic resin implant-supported prostheses. METHODS Seventy-six patients were rehabilitated consecutively with 100 full-arch implant-supported prostheses of PEEK-acrylic resin (a development group (DG): 37 patients with 5 years of follow-up; a routine group (RG): 39 patients with 1 year of follow-up). The primary outcome measure was prosthetic survival. Secondary outcome measures were implant survival, marginal bone loss, biological complications, prosthetic complications, veneer adhesion, plaque levels, bleeding levels, and a patient subjective evaluation (including the Oral Health Impact Profile for the RG). RESULTS In both groups, prosthetic (DG: 93.6%; RG: 100%) and implant survival (DG: 98.9%; RG: 99.5%) were high, and marginal bone loss was low (DG: 0.54 mm; RG: 0.28 mm). The veneer adhesion rate was 28.6% of prostheses in DG (RG = 0%). Mechanical complications occurred in 49% and 11.8% of prostheses in DG and RG, respectively. Biological complications, plaque, and bleeding levels were low in both groups. The subjective patient evaluation was excellent in both groups (8.6 < DG < 8.8; 9.3 < RG < 9.5; OHIP = 1.38). CONCLUSIONS Within the limitations of this study, PEEK can be considered a viable prosthetic alternative.
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Affiliation(s)
- Miguel de Araújo Nobre
- Research, Development and Education Department, MALO CLINIC, Avenida dos Combatentes, 43, Level 11, 1600-042 Lisboa, Portugal
| | - Carlos Moura Guedes
- Research, Prosthodontic Department, MALO CLINIC, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisboa, Portugal; (C.M.G.); (R.A.)
| | - Ricardo Almeida
- Research, Prosthodontic Department, MALO CLINIC, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisboa, Portugal; (C.M.G.); (R.A.)
| | - António Silva
- MALO CLINIC Ceramics, Avenida dos Combatentes, 43, Level 11, 1600-042 Lisboa, Portugal;
| | - Nuno Sereno
- Invibio Biomaterial Solutions & JUVORA, Global Technology Center, Hillhouse International, Thornton, Cleveleys FY5 4QD, UK;
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Cortese A, Spirito F, Claudio PP, Lo Muzio L, Ruggiero A, Gargiulo M. Mandibular Reconstruction after Resection of Ameloblastoma by Custom-Made CAD/CAM Mandibular Titanium Prosthesis: Two Case Reports, Finite Element Analysis and Discussion of the Technique. Dent J (Basel) 2023; 11:dj11040106. [PMID: 37185484 PMCID: PMC10137091 DOI: 10.3390/dj11040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Virtual surgical planning for CAD/CAM mandibular reconstruction by titanium prosthesis was recently reported for resected cases. Even if some advantages are evident, difficulties that may arise for TMJ function after reconstruction originate from prosthesis contamination through oral mucosa dehiscence. In these two cases reported of mandibular reconstruction after resection of ameloblastoma by custom-made CAD/CAM titanium prosthesis, the procedures were aimed to preserve the TMJ glenoid cavity and articular disc avoiding functional problems for hemi-mandibular resections that included the condyle (as in case #1) or with condylar preservation (as in case #2) and avoiding intraoral incisions in both cases. The entire surgical planning and prosthetic fabrication were explained with specifications and the sequence of the surgical procedure. Finite elements analysis (FEA) was performed to check the force distribution and efficacy of the prosthetic device (case 1 with hemi-mandibular resection and rehabilitation). Although successful in these two cases, surgical reconstruction of the mandibular defect after resection by a CAD-CAM custom-made prosthesis still shows some drawbacks and failure risks. Several advantages of this technique and the surgical success in these two cases were presented, but limitations and side effects must be considered when cases are selected.
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Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine, Surgery, and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Pier Paolo Claudio
- Department of Pharmacology and Toxicology, Cancer Center & Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Maxillofacial Surgery, Cancer Center & Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Alessandro Ruggiero
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, Nr. 132, 84084 Fisciano, Italy
| | - Maurizio Gargiulo
- U.O.C. Chirurgia Maxillofacciale, A.O.R.N. "A. Cardarelli", Via A. Cardarelli, 80131 Naples, Italy
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Epifania E, di Lauro AE, Ausiello P, Mancone A, Garcia-Godoy F, Mendes Tribst JP. Effect of crown stiffness and prosthetic screw absence on the stress distribution in implant-supported restoration: A 3D finite element analysis. PLoS One 2023; 18:e0285421. [PMID: 37146083 PMCID: PMC10162567 DOI: 10.1371/journal.pone.0285421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
This in-silico investigation evaluated the mechanical impact of Morse tape implant-abutment interface and retention system (with and without screw) and restorative materials (composite block and monolithic zirconia) by means of a three-dimensional finite element analysis (3D-FEA). Four 3D models were designed for the lower first molar. A dental implant (4.5 × 10 mm B&B Dental Implant Company) was digitized (micro CT) and exported to computer-aided design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model. Four different models were generated with the same Morse-type connection, but with a different locking system (with and without active screw) and a different crown material made of composite block and zirconia. The D2 bone type, which contains cortical and trabecular tissues, was designed using data from the database. The implants were juxtaposed inside the model after Boolean subtraction. Implant placement depth was simulated for the implant model precisely at crestal bone level. Each acquired model was then imported into the finite element analysis (FEA) software as STEP files. The Von Mises equivalent strains were calculated for the peri-implant bone and the Von Mises stress for the prosthetic structures. The highest strain values in bone tissue occurred in the peri-implant bone interface and were comparable in the four implant models (8.2918e-004-8.6622e-004 mm/mm). The stress peak in the zirconia crown (64.4 MPa) was higher than in the composite crown (52.2 MPa) regardless of the presence of the prosthetic screw. The abutment showed the lowest stress peaks (99.71-92.28 MPa) when the screw was present (126.63-114.25 MPa). Based on this linear analysis, it is suggested that the absence of prosthetic screw increases the stress inside the abutment and implant, without effect on the crown and around the bone tissue. Stiffer crowns concentrate more stress on its structure, reducing the amount of stress on the abutment.
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Affiliation(s)
- Ettore Epifania
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Alessandro E di Lauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Pietro Ausiello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Alessia Mancone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry-University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - João Paulo Mendes Tribst
- Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam en Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Desai SR, Koulgikar KD, Alqhtani NR, Alqahtani AR, Alqahtani AS, Alenazi A, Heboyan A, Fernandes GVO, Mustafa M. Three-Dimensional FEA Analysis of the Stress Distribution on Titanium and Graphene Frameworks Supported by 3 or 6-Implant Models. Biomimetics (Basel) 2023; 8:biomimetics8010015. [PMID: 36648801 PMCID: PMC9844420 DOI: 10.3390/biomimetics8010015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Titanium is the main component of dental implants. It is also routinely used as a framework material for implant-supported full-arch prostheses due to its low density, biocompatibility, and other mechanical properties. Remarkable mechanical properties such as lesser mass density and higher young's modulus of graphene have gained popularity among scientists, improving the properties of biomedical implants. Thus, our study aimed to compare the outcome through the von Mises stresses generated on All-on-6 and All-on-3 implant models, as well as on the framework, and evaluate the effect of stress patterns on the crestal bone around implants in the mandible. FEA (Finite Element Analysis) study was carried out using edentulous mandible models. Four 3D FEA models with 3 and 6 implants were used (Model 1: Titanium bar-supported 6 straight implants; Model 2: Graphene bar-supported 6 straight implants; Model 3: Titanium bar-supported 3 implants with 30 degrees-tilted; Model 4: Graphene bar-supported 3 implants with 30 degrees-tilted) in order to simulate endosseous implant designs. The implant measuring 4.2 mm in diameter and 11.5 mm in length were used. The most distal implants in the 3-implant models were placed with angulation of 30 degrees; in 6 implants, they were vertically placed. All the models were analyzed for vertical and oblique axis with a single force magnitude of 100 N. In all four implant models and under loading conditions, the peak stress points were always on the neck of the most distal implant. von Mises stresses were within the normal stress range. In a conventional six-straight implant model supported by a titanium framework, the cortical stress in the region of implants was 25.27 MPa, whereas, in the graphene framework, it was 12.18 MPa. Under vertical load, there was a significant difference in the cortical stress around the tilted implants (30 degrees) in the 3-implant system of titanium and graphene frameworks, respectively, 70.31 MPa and 21.27 MPa. The graphene framework demonstrated better results than the titanium framework for the conventional six-implant system under vertical load, achieving stress of 30.09 MPa and 76.60 MPa, respectively. In the case of the 3-implant system, a significant difference in the bar stress was observed between graphene and titanium, respectively, 256.32 MPa and 180.1 MPa of bar stress. Within the limitation of this study, the peri-implant stresses were decreased using graphene framework models. Hence, it was possible to conclude that the best load-bearing capacity results were found in the graphene framework group compared to the titanium framework for All-on-6 and All-on-3 implant models, even though both materials are reliable options used as framework materials in implant-supported full-arch prostheses.
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Affiliation(s)
- Shrikar R. Desai
- Department of Periodontology and Implantology, HKE’S S. Nijalingappa Institute of Dental Sciences and Research, Kalaburagi 585105, India
| | - Kiran Deepak Koulgikar
- Department of Periodontology and Implantology, HKE’S S. Nijalingappa Institute of Dental Sciences and Research, Kalaburagi 585105, India
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ali Robaian Alqahtani
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdullah Saad Alqahtani
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Adel Alenazi
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan 0025, Armenia
| | - Gustavo V. O. Fernandes
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, 1011 North University Ave, Ann Arbor, MI 48109, USA
- Correspondence: (G.V.O.F.); (M.M.)
| | - Mohammed Mustafa
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Correspondence: (G.V.O.F.); (M.M.)
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Anitua E, Larrazabal Saez de Ibarra N, Saracho Rotaeche L. Implant-Supported Prostheses in the Edentulous Mandible: Biomechanical Analysis of Different Implant Configurations via Finite Element Analysis. Dent J (Basel) 2022; 11:dj11010004. [PMID: 36661541 PMCID: PMC9858073 DOI: 10.3390/dj11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
This study explores the implant-supported prosthetic treatment alternatives of the edentulous mandible from a biomechanical point of view by means of a Finite Element Analysis (FEA). Finite element (FE) models were used to simulate cases treated with six, five, and four, implants and a fixed prosthesis with a cantilever. In the four implant treatments, three cases were analyzed; the posterior implants were placed in axial positions, angled at 30° and 45°. Cases with six and four axially placed implants were also analyzed by placing the posterior implants distally to the foramen, thus eliminating the cantilever in the prostheses. In the cases with implants between foramina, the highest values for the principal strains and von Mises stresses were observed in the case with four implants where the posterior implants were angled at 45°. Cases with implants placed distally to the foramen and without a cantilever showed much lower bone stress and strain levels compared to cases with implants between foramina. From a biomechanical point of view, it seems to be a better option to use implants positioned distally to the foramen, eliminating cantilevers.
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12
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Topcu Ersöz MB, Mumcu E. Biomechanical investigation of maxillary implant-supported full-arch prostheses produced with different framework materials: a finite elements study. J Adv Prosthodont 2022; 14:346-359. [PMID: 36685790 PMCID: PMC9832146 DOI: 10.4047/jap.2022.14.6.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Four and six implant-supported fixed full-arch prostheses with various framework materials were assessed under different loading conditions. MATERIALS AND METHODS In the edentulous maxilla, the implants were positioned in a configuration of four to six implant modalities. CoCr, Ti, ZrO2, and PEEK materials were used to produce the prosthetic structure. Using finite element stress analysis, the first molar was subjected to a 200 N axial and 45° oblique force. Stresses were measured on the bone, implants, abutment screw, abutment, and prosthetic screw. The Von Mises, maximum, and minimum principal stress values were calculated and compared. RESULTS The maximum and minimum principal stresses in bone were determined as CoCr < ZrO2 < Ti < PEEK. The Von Mises stresses on the implant, implant screw, abutment, and prosthetic screws were determined as CoCr < ZrO2 < Ti < PEEK. The highest Von Mises stress was 9584.4 Mpa in PEEK material on the prosthetic screw under 4 implant-oblique loading. The highest maximum principal stress value in bone was found to be 120.89 Mpa, for PEEK in 4 implant-oblique loading. CONCLUSION For four and six implant-supported structures, and depending on the loading condition, the system accumulated different stresses. The distribution of stress was reduced in materials with a high elastic modulus. When choosing materials for implant-supported fixed prostheses, it is essential to consider both the number of implants and the mechanical and physical attributes of the framework material.
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Affiliation(s)
- Mirac Berke Topcu Ersöz
- Department of Prosthodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Emre Mumcu
- Department of Prosthodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey.,Advanced Material Technologies Application and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey.,Translational Medicine Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
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Biomechanical Comparison of Asymmetric Implant Configurations for All-on-Four Treatment Using Three-Dimensional Finite Element Analysis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121963. [PMID: 36556328 PMCID: PMC9783018 DOI: 10.3390/life12121963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study is to examine the effect of unilaterally more posterior placement of implants (Straumann BLT 4.1 mm in diameter and 12 mm long) applied according to the all-on-four concept on the stress distribution on bone, implants, and other prosthetic components, using the finite element analysis method. Three scenarios were modelled: For Model 1 (M1), anterior implants were placed symmetrically perpendicular to the bone in the right and left lateral incisor region, while the necks of the posterior implants placed symmetrically in the second premolar region were angled at 30 degrees. For Model 2 (M2) the implant in the left second premolar region was placed to the first molar region unilaterally. For Model 3 (M3) the implant in the left lateral incisor region was placed to the canine region unilaterally. Vertical and oblique forces (100 N) were applied in the right first molar region. The von Mises and maximum (Pmax) and minimum (Pmin) principal stresses were obtained. The highest stress concentration on the cortical bone was observed in the second premolar region in all models when oblique forces were applied. M1 was highest (8.992 MPa) followed closely by M3 (8.780 MPa) and M2 was lowest (3.692 MPa). The highest stress concentration on the prosthetic parts was observed in this framework when oblique forces were applied. M2 was highest (621.43 MPa) followed by M3 (409.16 MPa) and the lowest was M1 (309.43 MPa). It is thought that placing the implant further posterior to first molar region may prevent the bone resorption that occurs with high stress around the crestal bone. However, increased stress on the implants and prosthetic parts may lead to failures.
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Lopes GDRS, de Matos JDM, Queiroz DA, Tribst JPM, Ramos NDC, Rocha MG, Barbosa AB, Bottino MA, Borges ALS, Nishioka RS. Influence of Abutment Design on Biomechanical Behavior to Support a Screw-Retained 3-Unit Fixed Partial Denture. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6235. [PMID: 36143553 PMCID: PMC9504379 DOI: 10.3390/ma15186235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Guilherme da Rocha Scalzer Lopes
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
| | - Jefferson David Melo de Matos
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
- Center for Dental Biomaterials, Department of Restorative Dental Sciences, University of Florida (UF Health), Gainesville, FL 32611, USA
| | - Daher Antonio Queiroz
- Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, TX 77054, USA
| | - João Paulo Mendes Tribst
- Department of Oral Regenerative Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands
| | - Nathália de Carvalho Ramos
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
- Department of Dentistry, Universidade São Francisco (USF), Bragança Paulista 12916-900, Brazil
| | - Mateus Garcia Rocha
- Center for Dental Biomaterials, Department of Restorative Dental Sciences, University of Florida (UF Health), Gainesville, FL 32611, USA
| | | | - Marco Antonio Bottino
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
| | - Alexandre Luiz Souto Borges
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
| | - Renato Sussumu Nishioka
- Department of Biomaterials, Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos 12245-000, Brazil or
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15
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Mourad KE, Altonbary GY, Emera RMK, Hegazy SAF. Polyetheretherketone CAD-CAM framework for all-on-4 mandibular full arch prosthesis: Three years' retrospective study of periimplant soft tissue changes and ridge base relationship. J Prosthodont 2022. [PMID: 36069047 DOI: 10.1111/jopr.13602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to evaluate the clinical peri-implant soft tissue changes during first year after occlusal loading and the ridge base relation after three years for mandibular CAD-CAM manufactured screw-retained implant-supported hybrid prosthesis of polyetheretherketone (PEEK) framework utilized with All-on-Four treatment concept. MATERIAL AND METHODS Sixteen completely edentulous patients were rehabilitated by 4 implants following the All-On-Four protocol. After 3 months, the definitive prosthesis was constructed to be a screw retained CAD-CAM milled framework from the modified PEEK (BioHPP), bonded to polymethylmethacrylate (PMMA) teeth and a pink shaded indirect light-polymerized nanofilled composite resin imitating the soft tissues. Peri-implant soft tissue changes regarding plaque, bleeding, gingival scores, and probing depth were evaluated at prosthesis insertion (T0), six months (T1) and 12 months (T2) after insertion. Also, monitoring of the ridge base relation was performed using cone beam computed tomography after one year (T0), two years (T1), and three years (T2) after mandibular fixed detachable All-on-Four framework insertion. Using Shapiro Wilk tests using SPSS® software version 22 (SPSS Inc.), all clinical data were non- parametric while the ridge base relation data was parametric. RESULTS There were statistically significant differences regarding plaque, gingival, and bleeding scores for all implants with advancement of time. However, there was a statistically insignificant difference regarding probing depth in the posterior implants (p = .581). Regarding ridge base relation, there was a significant difference between observation times only in the anterior ridge area in between the two anterior implants (p = .011). CONCLUSION Within limitations of the study, the full arch PEEK framework of fixed-detachable, hybrid prosthesis used with All-on-Four concept for rehabilitation of mandibular edentulous arches is an acceptable treatment approach. Based on the stable ridge base relation posteriorly found in this study, less stress is distributed to the underlining bone due to the shock absorbing ability of PEEK. Special considerations for frequent soft tissue follow up and regular maintenance of oral hygiene measures are recommended. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Khloud E Mourad
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Gilan Y Altonbary
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Radwa M K Emera
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Salah A F Hegazy
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Van Doorne L, Hommez G, Bronkhorst E, Meijer G, De Bruyn H. Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up. J Clin Med 2022; 11:jcm11154637. [PMID: 35956252 PMCID: PMC9369462 DOI: 10.3390/jcm11154637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years.
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Affiliation(s)
- Luc Van Doorne
- Department of Plastic, Oral and Maxillo-Facial Surgery, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Dentistry, Prosthetic Dentistry, Endodontics, Oral and Maxillo-Facial Surgery, Private Clinic “Het Tandplein”, Bilkske 68, 8000 Brugge, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Heymanslaan 10, 9000 Ghent, Belgium
- Correspondence: or or (L.V.D.); or (H.D.B.); Tel.: +32-0474-248045 or +32-0496-804040 (L.V.D.)
| | - Geert Hommez
- Dentistry, Prosthetic Dentistry, Endodontics, Oral and Maxillo-Facial Surgery, Private Clinic “Het Tandplein”, Bilkske 68, 8000 Brugge, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Heymanslaan 10, 9000 Ghent, Belgium
| | - Ewald Bronkhorst
- Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Gert Meijer
- Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Hugo De Bruyn
- Faculty of Medicine and Health Sciences, Ghent University, Heymanslaan 10, 9000 Ghent, Belgium
- Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Correspondence: or or (L.V.D.); or (H.D.B.); Tel.: +32-0474-248045 or +32-0496-804040 (L.V.D.)
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Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials. MATERIALS 2022; 15:ma15144953. [PMID: 35888420 PMCID: PMC9323759 DOI: 10.3390/ma15144953] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/25/2022]
Abstract
The aim of this study was to assess and compare the stress–strain pattern of zygomatic dental implants supporting different superstructures using 3D finite element analysis (FEA). A model of a tridimensional edentulous maxilla with four dental implants was designed using the computer-aided design (CAD) software. Two standard and two zygomatic implants were positioned to support the U-shaped bar superstructure. In the computer-aided engineering (CAE) software, different materials have been simulated for the superstructure: cobalt–chrome (CoCr) alloy, titanium alloy (Ti), zirconia (Zr), carbon-fiber polymers (CF) and polyetheretherketone (PEEK). An axial load of 500 N was applied in the posterior regions near the zygomatic implants. Considering the mechanical response of the bone tissue, all superstructure materials resulted in homogeneous strain and thus could reconstruct the edentulous maxilla. However, with the aim to reduce the stress in the zygomatic implants and prosthetic screws, stiffer materials, such Zr, CoCr and Ti, appeared to be a preferable option.
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Szabó ÁL, Nagy ÁL, Lászlófy C, Gajdács M, Bencsik P, Kárpáti K, Baráth Z. Distally Tilted Implants According to the All-on-Four ® Treatment Concept for the Rehabilitation of Complete Edentulism: A 3.5-Year Retrospective Radiographic Study of Clinical Outcomes and Marginal Bone Level Changes. Dent J (Basel) 2022; 10:dj10050082. [PMID: 35621535 PMCID: PMC9140184 DOI: 10.3390/dj10050082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Bone grafting procedures during the use of dental implants may be avoided by the use of tilted implants in the maxilla and the mandible; advantages of angled implants are associated with the extension of the distal cantilever, leading to better implant survival rates. However, the bending effect on the single tilting implants may increase the marginal bone stress. The purpose of the present study was to retrospectively assess the clinical success and proximal bone loss rate following the implantation of distally tilted implants according to the All-on-Four™ prosthetic concept—based on radiographic findings—in a single-center experience, in addition to the assessment of the outcomes in the context of various clinico-epidemiological correlates. During the study period, n = 36 patients (24 males and 12 females) with complete records of periapical radiographs, received a full-arch fixed bridge supported by two axial and two distal tilted implants; overall n = 144 and n = 144 implants (Nobel B) were place in the maxilla and mandibles of patients, respectively. Mean age of patients at the time of fixture installation was 58.75 ± 13.71 years; n =11 patients presented with relevant underlying conditions/habits. To assess peri-implant bone-level changes, matched and calibrated orthopantomogram (OPT) images were taken at follow-ups after 1.5 years, 2.5 years, and 3.5 years post-restoration, and marginal bone levels were assessed on the mesio- (MA) and disto-approximal (DA) aspects. All implants were successful, resulting in a 100% overall survival rate. The radiographic mean bone loss levels at baseline (mean ± SEM) were 0.181 ± 0.011 mm and 0.178 ± 0.017 mm in the maxilla and mandible, respectively, while by the 3.5-year mark, bone loss was 0.770 ± 0.029 mm and 0.713 ± 0.026 mm in the maxilla and mandible (p > 0.05), respectively; bone-level changes were significant over time (p = 0.035 and p = 0.033). Peri-implant bone loss was more aggressive around titled distal implants versus mesial actual position implants. The effect of smoking and other underlying conditions showed significantly higher (p < 0.05) bone resorption levels when assessed on an individual implant-level, while during patient-level analysis, only a tendency was shown for higher bone loss rates for both MA and DA implants (p > 0.05). Within its limitations, our study has concluded that the use of All-on-Four™ prosthetic concept for total arch rehabilitation yields higher bone loss in association with tilted implants and, in some cases, on the MA surfaces at vertically positioned implants after >40 months in function.
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Affiliation(s)
- Árpád László Szabó
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos körút 62-64, 6720 Szeged, Hungary; (Á.L.S.); (Á.L.N.)
- Oral Centrum Dental Ltd., Angyalka u. 1/A, 2030 Érd, Hungary
| | - Ádám László Nagy
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos körút 62-64, 6720 Szeged, Hungary; (Á.L.S.); (Á.L.N.)
| | - Csaba Lászlófy
- Sanoral Healthcare Ltd., Ó utca 6, 1066 Budapest, Hungary;
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 63., 6720 Szeged, Hungary;
| | - Péter Bencsik
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 12, 6721 Szeged, Hungary;
| | - Krisztina Kárpáti
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos körút 62-64, 6720 Szeged, Hungary;
| | - Zoltán Baráth
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos körút 62-64, 6720 Szeged, Hungary; (Á.L.S.); (Á.L.N.)
- Correspondence: or ; Tel.: +36-62-545-297
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Microbial Adhesion to Dental Polymers for Conventional, Computer-Aided Subtractive and Additive Manufacturing: A Comparative In Vitro Study. J Funct Biomater 2022; 13:jfb13020042. [PMID: 35466224 PMCID: PMC9036260 DOI: 10.3390/jfb13020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
Modern structural materials are represented by a variety of polymer materials used for dental patients’ rehabilitation. They differ not only in physico-chemical properties, but also in microbiological properties, which is one of the reasons why these materials are chosen. The study focused on the microbial adhesion of clinical isolates of normal (5 types), periodontopathogenic (2 types), and fungal (2 types) microbiotas to various materials based on polymethylmethacrylate (PMMA) intended for traditional (cold-cured and hot-cured polymers), computer-aided subtractive and additive manufacturing. A comparative analysis was carried out on the studied samples of polymer materials according to the microorganisms’ adhesion index (AI). The lowest level of microorganisms’ AI of the three types of microbiotas was determined in relation to materials for additive manufacturing. The AI of hot-cured polymers, as well as materials for subtractive manufacturing, corresponded to the average level. The highest level of microorganisms’ adhesion was found in cold-cured polymers. Significant differences in AI for materials of the same technological production type (different manufacturers) were also determined. The tendency of significant differences in the indicators of the microorganisms’ adhesion level for the studied polymer materials on the basis of the type of production technology was determined.
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Influence of Bone-Level Dental Implants Placement and of Cortical Thickness on Osseointegration: In Silico and In Vivo Analyses. J Clin Med 2022; 11:jcm11041027. [PMID: 35207298 PMCID: PMC8879296 DOI: 10.3390/jcm11041027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
The purpose of this research is to study the biomechanical response of dental implants in bone-level type locations, 0.5 mm above and below the bone level. In addition, the influence of the thickness of the cortical bone on osseointegration is determined due to the mechanical loads transfer from the dental implant to the cortical and trabecular bone. The thicknesses studied were 1.5 mm and 2.5 mm. Numerical simulations were performed using a finite element method (FEM)-based model. In order to verify the FEM model, the in silico results were compared with the results obtained from a histological analysis performed in an in vivo study with 30 New Zealand rabbits. FEM was performed using a computerized 3D model of bone-level dental implants inserted in the lower jawbone with an applied axial load of 100 N. The analysis was performed using different distances from the bone level and different thicknesses of cortical bone. The interface area of bone growth was evaluated by analyzing the bone–implant contact (BIC), region of interest (ROI) and total bone area (BAT) parameters obtained through an in vivo histological process and analyzed by scanning electron microscopy (SEM). Bone-level implants were inserted in the rabbit tibiae, with two implants placed per tibia. These parameters were evaluated after three or six weeks of implantation. FEM studies showed that placements 0.5 mm below the bone level presented lower values of stress distribution compared to the other studied placements. The lower levels of mechanical stress were then correlated with the in vivo studies, showing that this position presented the highest BIC value after three or six weeks of implantation. In this placement, vertical bone growth could be observed up the bone level. The smallest thickness of the study showed a better transfer of mechanical loads, which leads to a better osseointegration. In silico and in vivo results both concluded that the implants placed 0.5 mm below the cortical bone and with lower thicknesses presented the best biomechanical and histological behavior in terms of new bone formation, enhanced mechanical stability and optimum osseointegration.
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