Influence of implant design and length on stress distribution in immediately loaded implants in posterior maxilla - A two-dimensional finite element analysis

Aim

The aim of this two dimensional (2D) finite element analysis study was to evaluate the influence of implant design (step and tapered) and length on stress distribution at bone implant interface, when placed in maxillary posterior bone under immediate loading protocol.

Materials and Methods

2D finite element models were developed to simulate the two types of implant designs, i.e., Tapered and step implants of 3.75-mm - Diameter and 6 and 10 mm lengths, respectively. Maxillary posterior bone quality (D4 bone) was simulated with a very thin cortical bone (0.5 mm) for the placement of implants. The respective material properties were assigned. The implant designs incorporated microthreads at the crestal part and rest of the implant body incorporated Acme threads. Forces of 100 Newtons were applied vertically and in oblique direction (at an angle of 45°) to long axis of the implants. Total deformation (micromovements), stresses and strains were evaluated at the bone implant interface.

Results

The results of micromovements, stresses and strains were found to be lower for long implants as compared to short implants. Also, all the values were found to be higher for oblique loads as compared to vertical loads. The von mises stress values were highest for 6 mm step implants and lowest for 10 mm step implants.

Conclusion

In the presence of low bone density with optimal bone height, standard diameter long step implants can be used. Incorporation of microthreads at the crestal portion and acme threads for body portion of the implant presents a good option to be used under immediate loading protocol.

The Effect of Implant Length and Diameter on Stress Distribution of Tooth-Implant and Implant Supported Fixed Prostheses: An In Vitro Finite Element Analysis Study

The aim of this study is to evaluate the effectiveness of the implant diameter and length on force dissemination of tooth-implant and implant retained fixed restorations. A finite analysis model was used via a 3D simulation of a unilateral mandibular Kennedy Class I arch. Through thresholding the resultant assembly, a region of interest was selected from the computed tomography (CT) scan. Details of the diameter (D) and length (L) of implant were introduced. Ds used were 3.7, 4.7, and 5.7, while Ls used were 10, 11.5, and 13. The constant was the use of rigid connectors in both designs (implant-implant and implant-tooth fixed partial dentures [FPDs]) and the mesial implant (D 3.7 and L 11.5). Stress in cancellous bone around mesial abutment, which is the second premolar in tooth-implant FPD and mesial implant in the implant-implant FPD, revealed that the stress was significantly lower in tooth-implant FPD when compared with implant-implant FPD (21.1 ± 0.00 vs 46.1 ± 0.00, P < .001). Stress distribution in the bone around any implant depends on several factors such as diameter, length, and tooth-implant vs implant-implant support. The implant diameter was more significant for improved stress distribution than implant length. A moderate increase in the length of the implant consequently reduced stress.

Stress Distribution Analysis of Threaded Implants for Digital Dentistry

In this study, stability evaluation is performed through structural analysis based on digital dental implant design variables. The design variables include the implant length and thickness, cortical bone thickness, and elastic modulus of the cancellous bone. Subsequently, the stress in the external cortical bone, in which numerous nerves exist, is analyzed. Results show that stress increases as the implant length decreases. However, when the implant length is 10 mm, the stress decreases, owing to stress dispersion at the lower section of the implant. Moreover, as the implant thickness increases, the stress decreases. As the elastic modulus of the cancellous bone decreases, the stress exerted on the cancellous bone decreases; consequently, the stress exerted on the cortical bone increases. Finally, as the thickness of the cortical bone increases, the stress decreases when a vertical load is applied. However, when a load is applied in the oblique direction, the stress increases. Based on data obtained via digital radiography, which is a digital dental technology, a more precise implantation plan will be established by substituting the data via structural analysis.

Biomechanical Evaluation of Bone Atrophy and Implant Length in Four Implants Supporting Mandibular Full-Arch-Fixed Dentures

Residual alveolar ridge resorption often occurs after tooth extraction, which causes issues requiring further prothesis rehabilitation. A treatment concept referred to as all-on-four, involving fixed dentures supported with four implants, was recently developed. The current study aimed to determine the effect of changing bone atrophy and implant length in all-on-four treatments on stress and strain in the surrounding bone of the implant. A three-dimensional finite element method was used in this research. The stress analysis was conducted with von Mises stress values. Two types of synthetic jawbone models with mild and moderate atrophy were used. Furthermore, two different implant lengths with a similar implant design and diameter were selected, and they were classified into eight models. Then, the bone model was assessed via a computed tomography (CT) scan and was transformed into a virtual model in Geomagic and SolidWorks with implant rebuilding. After modifying bone atrophy, the von Mises stresses in the surrounding bone of the implant were as follows: mild type 2 < mild type 3 < moderate type 3 < moderate type 4. The bone quantity change rate increased more than when bone conditions were limited. Compared with changes in implant lengths, the stresses in the peri-implant surrounding bone were generally higher in the 9 mm implant length group than in the 11.5 mm group. However, the results did not significantly differ. In conclusion, the von Mises stress and strain increased in the models with moderate atrophy and low-density trabecular bone. Hence, bone atrophy and its presurgical diagnosis in long-term implant prognosis are crucial.

The Effect of Implant Length and Diameter on Stress Distribution around Single Implant Placement in 3D Posterior Mandibular FE Model Directly Constructed Form In Vivo CT

A three-dimensional (3D) finite element (FE) model of the mandibular bone was created from 3D X-ray CT scan images of a live human subject. Simulating the clinical situation of implant therapy at the mandibular first molar, virtual extraction of the tooth was performed at the 3D FE mandibular model, and 12 different implant diameters and lengths were virtually inserted in order to carry out a mechanical analysis. (1) High stress concentration was found at the surfaces of the buccal and lingual peri-implant bone adjacent to the sides of the neck in all the implants. (2) The greatest stress value was approximately 6.0 MPa with implant diameter of 3.8 mm, approx. 4.5 MPa with implant diameter of 4.3 mm, and approx. 3.2 MPa with implant diameter of 6.0 mm. (3) The stress on the peri-implant bone was found to decrease with increasing length and mainly in diameter of the implant.

Effect of Loading Angles and Implant Lengths on the Static and Fatigue Fractures of Dental Implants

Mechanical properties play a key role in the failure of dental implants. Dental implants require fatigue life testing before clinical application, but this process takes a lot of time. This study investigated the effect of various loading angles and implant lengths on the static fracture and fatigue life of dental implants. Implants with lengths of 9 mm and 11 mm were prepared. Static fracture tests and dynamic fatigue life tests were performed under three loading angles (30°, 40°, and 50°), and the level arm and bending moment were measured. After that, the fracture morphology and fracture mode of the implant were observed. The results showed that 9 mm length implants have a higher static failure load and can withstand greater bending moments, while 11 mm length implants have a longer fatigue life. In addition, as the loading angle increases, the static strength and bending moment decrease linearly, and the fatigue life shows an exponential decrease at a rate of three times. Increasing the loading angle reduces the time of the implant fatigue test, which may be an effective method to improve the efficiency of the experiment.

Potential Circumferential Bone Engagement following Tooth Extraction in the Posterior Mandible: Computed Tomography Assessment

Background and Objectives: Immediate implant placement (IIP) is a popular surgical procedure with a 94.9–98.4% survival rate and 97.8–100% success rate. In the posterior mandible, it poses a risk of injury to adjacent anatomical structures if the implant engages apical bone. This study sought to assess the implant dimensions that allow for circumferential bone engagement at each position in the posterior mandible without additional apical drilling. Materials and Methods: An observational, cross-sectional study design was used. The pre-extraction cone beam computed tomography scans of 100 candidates for IIP were analyzed. Measurements of each root of the posterior mandibular second premolar, first molar, and second molar were taken from three aspects: buccolingual, mesiodistal, and vertical. Two-sided p values < 0.05 were considered statistically significant. Results: A total of 478 mandibular teeth and 781 roots were assessed. Based on Straumann^® BLX/BLT implant-drilling protocols, predicted rates of radiological circumferential engagement (RCE) were 96% for implants 5 mm in diameter in the second premolar root position; 94% for implants 4.0–4.2 mm in diameter in the first molar root position; and 99% for implants 4.5–4.8 mm in diameter in the second molar root position. Corresponding rates of achieving an available implant length (AIL) of 10 mm were 99%, 90%, and 86%. Patients <40 years old were at higher risk of lower RCE and lower AIL (p < 0.005) than older patients for all roots measured. Conclusions: The high primary stability prediction rates based on the calculation of RCE and AIL support the use of IIPs without further apical drilling in the posterior mandible in most cases.

The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis

The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

Correlation between Primary, Secondary Stability, Bone Density, Percentage of Vital Bone Formation and Implant Size

BACKGROUND

This study aims to evaluate whether there is a correlation between implant stability, bone density, vital bone formation and implant diameter and length.

METHODS

Ninety patients were enrolled in this study. They underwent a socket preservation procedure with allograft or PRF and after 4 months, a total of 90 implants were placed. CBCT scans were assigned prior to implant placement in order to assess the bone density. During the surgical re-entry, a bone biopsy was harvested with a trephine drill. Immediately after implant insertion, the primary stability was measured. The secondary stability was measured 4 months after implant placement.

RESULTS

Primary stability showed a significant positive linear correlation with bone density (r = 0.471, p < 0.001) as well as with percentage of new bone formation (r = 0.567, p < 0.001). An average significant association of secondary stability with bone density (rs = 0.498, p < 0.001) and percentage of newly formed bone (r = 0.477, p < 0.001) was revealed. The mean values of primary stability in all three implant sizes, regarding the diameter of the implants, were similar (narrow 67.75; standard 66.78; wide 71.21) with no significant difference (p = 0.262). The same tendency was observed for secondary stability (narrow 73.83; standard 75.25; wide 74.93), with no significant difference (p = 0.277).

CONCLUSIONS

The study revealed a high correlation between primary and secondary implant stability, and bone density, as well as with the percentage of vital bone formation. Implant length and diameter revealed no linear correlation with the implant stability.

Survival Rate of 1008 Short Dental Implants with 21 Months of Average Follow-Up: A Retrospective Study

This retrospective study evaluated the survival rate of short, sandblasted acid-etched surfaced implants with 6 and 8 mm lengths with at least 120 days of follow-up. Data concerning patient, implant and surgery characteristics were retrieved from clinical records. Sandblasted and acid-etched (SLA)-surfaced tissue-level 6 mm (TL6) or 8 mm (TL8) implants or bone-level tapered 8 mm (BLT8) implants were used. Absolute and relative frequency distributions were calculated for qualitative variables and mean values and standard deviations for quantitative variables. A Cox regression model was performed to verify whether type, length and/or width influence the implant survival. The cumulative implant survival rate was assessed by time-to-event analyses (Kaplan–Meier estimator). In all, 513 patients with a mean age of 58.00 ± 12.44 years received 1008 dental implants with a mean follow-up of 21.57 ± 10.77 months. Most implants (78.17%) presented a 4.1 mm diameter, and the most frequent indication was a partially edentulous arch (44.15%). The most frequent locations were the posterior mandible (53.97%) and the posterior maxilla (31.55%). No significant differences were found in survival rates between groups of type, length and width of implant with the cumulative rate being 97.7% ± 0.5%. Within the limitations of this study, the evaluated short implants are a predictable option with high survival rates during the follow-up without statistical differences between the appraised types, lengths and widths.

Relationship between Implant Length and Implant Stability of Single-Implant Restorations: A 12-Month Follow-Up Clinical Study

Background and Objectives: Implant stability in vivo is contingent on multiple factors, such as bone structure, instrument positioning and implant surface modifications, implant diameter, and implant length. Resonance-frequency analysis is considered a non-invasive, reliable, predictable, and objective method by which to evaluate implant stability, due to its correlation with bone-to-implant contact. The purpose of this study was to evaluate the effect of implant length on the primary and secondary stability of single-implant crown rehabilitations, as measured by resonance-frequency analysis at different times. Materials and Methods: Implants of 10 and 11.5 mm were placed, and the resonance frequency was measured at the time of surgery (T0), as well as at 3 (T1), 6 (T2), and 12 (T3) months post-surgery. Results: A total of 559 implants were placed in 195 patients. Significant differences were observed when comparing the implant stability quotient (ISQ) values at T1, with values for 10-mm implants being greater than those for 11.5-mm implants (p = 0.035). These differences were also observed when comparing ISQ values for buccal and lingual areas. At T0, T2, and T3, no significant differences in ISQ values were observed. The use of 10-mm implants in the anterior maxilla yielded significantly greater values at T0 (p = 0.018) and T1 (p = 0.031) when compared with 11.5-mm implants. Significant differences in measurements were observed only for buccal areas (p = 0.005; p = 0.018). When comparing the sample lengths and sex, women with 11.5-mm implants showed significantly lower results than those with 10-mm implants (p < 0.001). Conclusions: There is a direct relationship between implants of a smaller length and greater ISQ values, with this relationship being most evident in the maxilla and in women.

Long-term follow-up of single crowns supported by short, moderately rough implants-A prospective 10-year cohort study

OBJECTIVES

To evaluate prospectively the clinical and radiographic outcomes after ten years of short (6 mm) implants with a moderately rough surface supporting single crowns in the posterior region.

MATERIAL AND METHODS

Forty 6 mm modified sandblasted large-grit acid-etched (mod-SLA), soft tissue level implants were installed in the distal segments of 35 consecutive patients. After 6 weeks of healing, abutments were tightened, and single porcelain-fused-to-metal crowns were cemented. Implant survival, marginal bone loss, and clinical crown/implant ratio were evaluated at various time intervals up to 10 years after loading.

RESULTS

Two out of the 40 implants were lost before loading, one implant was lost after 7 years because of peri-implantitis. One patient with two implants died and was excluded from analysis. Two patients did not come at the 10-year follow-up and were considered as drop out (2 implants). The survival rate was 91.7% (n = 36). Thirty-three implants were available for marginal bone loss evaluation. A mean marginal bone loss after 10 years of function was 0.8 ± 0.7 mm. Between 5 and 10 years, the loss was 0.2 ± 0.4 mm. No technical complications were registered during the 10-year period. The clinical crown/implant ratio increased with time from 1.6 at the delivery of the prosthesis to 2.0 after 10 years of loading with no increase between 5 and 10 years.

CONCLUSION

Short (6 mm) implants with a moderately rough surface supporting single crowns in the posterior region and loaded after 6-7 weeks maintained full function for at least 10 years with low marginal bone resorption.

Impact of implant diameter and length on stress distribution in osseointegrated implants: A 3D FEA study

Aims and Objectives:

Dimension of dental implant is an important parameter which has a considerable impact on the biomechanical load transfer characters and its prognosis. Excessive stress in the bone–implant interface may result in the failure of the implant. The aim of this study was to evaluate the impact of implant diameter and length on neighboring tissues around the implant. The results of the study will help in developing a scientific methodology to select appropriate implant diameter and length.

Materials and Methods:

In this study, tapered implants of different diameter and length were numerically analyzed using bone–implant models developed from computed tomography generated images of mandible with osseointegrated implants. The impact of various diameters on stress distribution was examined using implants with a length of 13 mm and diameters of 3.5 mm, 4.3 mm and 5.0 mm. Implants with a diameter of 4.3 mm and lengths of 10 mm, 13 mm, 16 mm was developed to examine the impact of various implant length. All materials were assumed to be linearly elastic and isotropic. Masticatory load was applied in a natural direction, oblique to the occlusal plane. The Statistical Package for the Social Sciences software package was used for statistical analysis.

Results:

Maximum von Mises stresses were located around the implant neck. It was demonstrated that there was statistically significant decrease in von Mises stress as the implant diameter increased.

Conclusion:

Within the limitations of this study there was statistically significant decrease in von Mises stress as the implant diameter increased.

[Three-dimensional finite element analysis of the effect of orbital implant lengths on stress distributions in peri-implant surfaces]

OBJECTIVE

This study aims to observe the effect of orbital implant lengths on stress distribution in peri-implant surfaces.

METHODS

The three-dimensional finite element analysis models of craniofacial and orbital implants with a diameter of 3.75 mm and lengths of 3, 4, 6, and 10 mm were established. A force of 20 N was applied to the models. The stress and displacement distribution under every condition were recorded and analyzed.

RESULTS

The loading direction along the implant axis and the stress concentration on the implant root were observed. The loading direction was at a 45 degree angle relative to the implant axis, and the stress concentration was located at the implant neck and the first screw thread. The maximum stress of the 3 mm implant was significantly higher than that under the other two loading directions. The maximum displacement of the four lengths exhibited no significant change. Given the same implant length, stress, and displacement, the peak of the implant axial direction was lower than that of the 45 degree direction. The loading type was an important factor influencing the stress and displacement of peri-implant bones.

CONCLUSION

The implants of more than 4 mm length can be considered for clinical use. The implant of 3 mm length should be implanted in a region with thicker cortical bone.

Accuracy of computerized vertical measurements on digital orthopantomographs: posterior mandibular region

OBJECTIVES

Orthopantomographs are commonly used for diagnosis in clinical dentistry. Although the manufacturers claim a constant magnification effect, the reliability of measuring dimensions on the panoramic radiographs is not clear. The aim of this study was to evaluate the accuracy of measuring vertical dimensions in the posterior mandibular area on digital orthopantomographs.

MATERIALS AND METHODS

A retrospective survey of 20 orthopantomographs with unrestored implants (only with cover screw) in the mandibular posterior region (molars and premolars) was conducted. All radiographs were taken using the same machine by skilled technicians. Two examiners were asked to measure the vertical dimension of the implants seen on the radiographs viewed using two differently sized display screens. Inter-examiner and intra-examiner reliability tests were performed. Differences between the measured length and the actual length using each screen type were compared.

RESULTS

High coefficients of reliability were observed on intra- and inter-examiner correlation. The overall reliability of measuring the vertical dimensions of implants between both examiners for the large screen and the small screen were 97.4% (Cronbach's alpha 0.993) and 94.0% (Cronbach's alpha 0.984), respectively. There were no significant differences between the errors seen with either the large screen or the small screen, when each of them was compared to the original length (P = 0.146).

CONCLUSION

This study shows that vertical dimensions in the posterior mandibular region (molar and premolars) can be reliably measured on an orthopantomograph using a calibrated machine and special software.

2D FEA of evaluation of micromovements and stresses at bone-implant interface in immediately loaded tapered implants in the posterior maxilla

AIM

The aim of the study is to evaluate the influence implant length on stress distribution at bone implant interface in single immediately loaded implants when placed in D4 bone quality.

MATERIALS AND METHODS

A 2-dimensional finite element models were developed to simulate two types of implant designs, standard 3.75 mm-diameter tapered body implants of 6 and 10 mm lengths. The implants were placed in D4 bone quality with a cortical bone thickness of 0.5 mm. The implant design incorporated microthreads at the crestal part and the rest of the implant body incorporated Acme threads. The Acme thread form has a 29° thread angle with a thread height half of the pitch; the apex and valley are flat. A 100 N of force was applied vertically and in the oblique direction (at an angle of 45°) to the long axis of the implants. The respective material properties were assigned. Micro-movements and stresses at the bone implant interface were evaluated.

RESULTS

The results of total deformation (micro-movement) and Von mises stress were found to be lower for tapered long implant (10 mm) than short implant (6 mm) while using both vertical as well as oblique loading.

CONCLUSION

Short implants can be successfully placed in poor bone quality under immediate loading protocol. The novel approach of the combination of microthreads at the crestal portion and acme threads for body portion of implant fixture gave promising results.