A Comparative 3D Finite Element Computational Study of Three Connections

Screw preload loss under occlusal load as a predictor of loosening risk in varying dental implant designs

PURPOSE

Screw loosening is a critical aspect of an implant design, as it can lead to implant failure. This study proposes a methodology and qualitatively assesses the potential of screw loosening risk for various types of screw heads and implant fixture-abutment connections. It is assumed that the risk of screw loosening is related to the drop in loosening moment under occlusal loads. The methodology and an assumption is verified by confronting the results with laboratory tests.

METHODS

Numerical simulations supplemented with semi-empirical equations were employed to estimate a loosening moment change under occlusal loads. The loosening risk was estimated by comparing the value before and after application of a compressive occlusal load of 150N. The procedure was carried out for 289 implant designs with smooth transition between flat to tapered shape of a screw head and an fixture-abutment connection. All analyses were conducted using Abaqus software. Pearson and Spearman correlation coefficients for normalised change in a screw loosening moment drop has been computed for numerical and laboratory tests.

RESULTS

The statistical analysis (Pearson, ρ = 0.8, Spearman, rs = 0.85) indicates very high correlation and confirms that the general tendencies observed in laboratory tests are reflected in the proposed procedure. The procedure was used for various geometries and the following results are presented: a screw loosening drop, implant stiffness and a tightening moment. The loosening moment drop achieves the extreme values of 6% and 24%. The biggest drop is an effect of a conical implant-abutment connection and a flat screw head while the lowest was recorded for a flat implant-abutment interface regardless of a screw head type. A low drop is also observed for a strongly conical screw head.

CONCLUSIONS

The proposed methodology exhibited very good correlation when confronted with laboratory tests, supporting a screw preload reduction under occlusal load as a key factor in screw loosening. Analysis across a wide spectrum of implant designs revealed geometry significantly impacts loosening potential under occlusal loads. Two key features were identified as favourable - an abutment-fixture butt joint and a tapered screw. The results also enable prediction of qualitative geometry effects on loosening risk.

Optimization of stress distribution of bone-implant interface (BII)

Many studies have found that the threshold of occlusal force tolerated by titanium-based implants is significantly lower than that of natural teeth due to differences in biomechanical mechanisms. Therefore, implants are considered to be susceptible to occlusal trauma. In clinical practice, many implants have shown satisfactory biocompatibility, but the balance between biomechanics and biofunction remains a huge clinical challenge. This paper comprehensively analyzes and summarizes various stress distribution optimization methods to explore strategies for improving the resistance of the implants to adverse stress. Improving stress resistance reduces occlusal trauma and shortens the gap between implants and natural teeth in occlusal function. The study found that: 1) specific implant-abutment connection design can change the force transfer efficiency and force conduction direction of the load at the BII; 2) reasonable implant surface structure and morphological character design can promote osseointegration, maintain alveolar bone height, and reduce the maximum effective stress at the BII; and 3) the elastic modulus of implants matched to surrounding bone tissue can reduce the stress shielding, resulting in a more uniform stress distribution at the BII. This study concluded that the core BII stress distribution optimization lies in increasing the stress distribution area and reducing the local stress peak value at the BII. This improves the biomechanical adaptability of the implants, increasing their long-term survival rate.

Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods

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.

Stress analysis and factor of safety in three dental implant systems by finite element analysis

Objective

The purpose of this study was to compare the stress distribution and the factor of safety of three dental implant systems using the finite element method.

Materials and methods

Three commercial dental implant systems were designed using Solid Works 2020 software: Model A with an internal octagonal connection and matching platform, Model B with an internal hexagon connection and switching platform, and Model C with an internal 15° conical-cylindrical connection and switching platform. A 200 N load was applied to each design in both axial and 30° oblique directions using the finite element method.

Results

In the three dental implant systems, the maximum von Mises stress was concentrated at the cervical level of the bone-implant interface in all models. Model C showed lower maximum stress values in both axial and 30° oblique loads. The highest maximum stress value was observed with the application of the oblique load in all the study models, and the factor of safety was less than one in Model A when subjected to a 200 N oblique load.

Conclusion

The switching platform models generated lower maximum stress values and a factor of safety higher than one which is considered an acceptable value.

Clinical relevance: A dental implant system with an internal hexagon or conical connection and a switching platform generates lower maximum von Mises stress values both on the implant components and on the peri-implant tissues.

Effect of Different Customized Abutment Types on Stress Distribution in Implant-Supported Single Crown: A 3D Finite Element Analysis

PURPOSE

The purpose was to investigate stress distribution among 4 different customized abutment types: titanium abutment (Ti), titanium hybrid-abutment-crown (Ti-Hybrid), zirconia abutment with titanium base (Zir-TiBase), and zirconia hybrid-abutment-crown with titanium base (Zir-Hybrid-TiBase).

MATERIALS AND METHODS

To achieve this purpose, 4 types of abutment configurations were simulated. A static load of 200 N (vertical) and 100 N (oblique) were applied to the models. The volume average, maximum, and stress distribution of von Mises stress, including percentage difference, were analyzed with three-dimensional finite element analysis.

RESULTS

According to the volume average von Mises stress, the Ti and Zir-TiBase comparison group showed that the Zir-TiBase group dominantly generated the higher value at Ti-base (22.57 MPa) and screw (17.68 MPa). To evaluate the effect of the hybrid-abutment-crown on volume average von Mises stress by comparing the Ti-Hybrid and Zir-Hybrid-TiBase groups, it was revealed that the combination of abutment and crown in the Ti-Hybrid group generated the worst stress concentration at the screw (12.42 MPa), while in the Zir-Hybrid-TiBase group presented stress concentration at the implant (8.90 MPa).

CONCLUSIONS

A titanium base improved stress distribution at implant in zirconia abutment with titanium base by absorbing stress itself. Customized titanium hybrid-abutment-crown and zirconia hybrid-abutment-crown with titanium base created concentrated stress at screw and implant; respectively. Both abutment types should be cautiously used and maintenanced regularly. This article is protected by copyright. All rights reserved.

Clinical and Laboratory Outcomes of Angled Screw Channel Implant Prostheses: A Systematic Review

The purpose of this systematic review was to evaluate the clinical and laboratory outcomes of angled screw channel (ASC) restorations and to summarize the influencing factors. An electronic search of the English language literature was performed in four databases and enriched by manual searches. Retrieved studies were screened against the predefined exclusion and inclusion criteria. Eight clinical and seven laboratory studies were eligible for the analysis. The risk of bias for included observational studies was performed using the Newcastle–Ottawa quality assessment scale. Laboratory studies quality assessment method was adapted from previous published systematic reviews. Two clinical studies focused on technical outcomes and the rest reported the biological outcomes of the ASC restorations. Out of the seven laboratory studies, two studies investigated the fracture resistance of ASC restorations, four studies evaluated the reverse torque value of the nonaxially tightened screws, and one study evaluated both variables. The present review revealed that while the performance of ASC restorations is promising in short-term clinical studies, the evidence of their long-term reliability is still lacking. The laboratory studies indicated comparable fracture resistance results of the ASC restorations with the straight screw channel restorations. In addition, factors, such as initial torque value, configuration of the screw driver, screw design, abutment system, and the angulation of screw channel, were shown to influence the screw resistance to loosening.

Behavior of implant and abutment sets of three different connections during the non-axial load application: An in vitro experimental study using a radiographic method

BACKGROUND

During the masticatory cycle, loads of different intensities and directions are received by the dental structures and/or implants, which can cause micromovements at the junction between the abutment and implant.

OBJECTIVE

The objective of this in vitro study was to evaluate the behavior of three different implant connections subjected to different load values using a digital radiography system. Additionally, the torque values for removing the abutment screws were also measured and compared.

METHODS

Ninety sets of implant and abutment (IA) were used, divided into three groups according to the type of connection (n = 30 per group): EH group, external hexagon type connection; IH group, internal hexagon connection; and, MT group, Morse taper connection.

RESULTS

MT group showed the better vertical misfit behavior at the three intensity of load applied, in comparison with EH and IH groups. In the analysis of torque maintenance (detorque test), MT group showed higher values of detorque when compared with the measured values of EH and IH groups (p < 0.001).

CONCLUSIONS

The IA sets of EH and IH groups showed a microgap in all levels of applied loads, unlike the MT group this event was not observed. In the detorque test, MT group increase in the torque values when compared to the initial torque applied, unlike EH and IH groups showed a decrease in the initially torque applied in all conditions tested. A positive correlation was detected between the misfit and detorque values.

Can transfer type and implant angulation affect impression accuracy? A 3D in vitro evaluation

Impression accuracy is fundamental to achieve a passive fit between implants and the superstructure. Three transfer types were tested to evaluate the differences in impression accuracy and their efficiency in case of different implant angles. A master model with four implant analogues placed at 0°, 15° and 35° was used. 27 impressions were taken with three different types of impression coping: closed tray technique coping (CT), open tray technique coping (COT) and telescopic open tray coping (TOT). The impressions were poured. Analogues were matched with scan bodies to be scanned and exported in STL. An implant bar was designed from each STL and another one from the master model. A comparison between these bars was obtained. Linear and angular measurements for every type of coping were calculated for different angulations. The collected data were analyzed with ANOVA test (95% of confidence). Student’s t test showed a significative discrepancy (p ≤ 0.001) on linear and angular measurements on Δx, Δy, Δz with different transfer types as well as diverse implant positioning angles (p ≤ 0.001). Within the limitations of this study, it can be concluded that the coping type and the implants divergence may be significant parameters influencing the impression accuracy.

Bioengineering Methods of Analysis and Medical Devices: A Current Trends and State of the Art

Implantology, prosthodontics, and orthodontics in all their variants, are medical and rehabilitative medical fields that have greatly benefited from bioengineering devices of investigation to improve the predictability of clinical rehabilitations. The finite element method involves the simulation of mechanical forces from an environment with infinite elements, to a simulation with finite elements. This editorial aims to point out all the progress made in the field of bioengineering and medicine. Instrumental investigations, such as finite element method (FEM), are an excellent tool that allows the evaluation of anatomical structures and any facilities for rehabilitation before moving on to experimentation on animals, so as to have mechanical characteristics and satisfactory load cycle testing. FEM analysis contributes substantially to the development of new technologies and new materials in the biomedical field. Thanks to the 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in the rehabilitations it is possible to consider all the mechanical characteristics, so that they could be analyzed in detail and improved where necessary.