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Studying the influence of thread features in osseo-integrated implants
, M. Martorelli
University of Molise, School of Engineering University of Naples, Federico II, School of Engineering
Thread parameterisation Osseo-integration FE modelling DOE design Bone-stress distribution
The present paper investigates the influence of implant design factors in terms of bone integrity and implant stability.
First of all, a 3D parametric CAD model was developed. Then, by defining domain settings and boundary conditions, a 3D FE model was created, accordingly. In order to simulate as well as possible the physical interaction at bone-implant interface, identity pairs were introduced. After generating different design scenarios with a DOE approach, the most significant design factors were obtained.
Massimo Martorelli Tel.: +39 081 7682470 Fax.: +39 081 7682470 e-mail: email@example.com Address: P. le Tecchio, 80, 80125, Naples - Italy
Finding of this research showed that the geometry of the screw-thread highly influences the implant stability. More specifically, thread-width and -tick assume a crucial role to reduce bone induced stresses and bone damage.
Discussion & Conclusion:
Starting from these preliminary results, future improvements will focus on investigating also two-factor and higher interactions to better understand the implant loading mechanism.
Dental implantology is a set of surgical techniques allowing to obtain, by using dental implants, the functional rehabilitation of a patient affected by partial or total edentulism. Dental implants can have different shapes, they can be inserted in different positions, and they remain incorporated in the patient’s bone by physiological bone regeneration actions. It was reported that osseo-integration is affected by many factors, including the implant design, surface treatment, bone quality, surgical technique, post-operative care . Among these, the thread design of an implant is one of the dominant factors. In particular, the total contact area between the implant and bone plays a significant role in the osseo-integration strength of implant-bone interfaces . In addition, the design of the implant threads directly affects the stress distribution and the marginal bone restoration . Over the years many experimental and clinical reports revealed that the first thread is the most stressed site, and thus the initial micro-fracture and eventually immature osseo-integration occur at this site. There are various commercial solutions for dental implants. Their designs are quite differ in terms of thread shape. Recent researches have focused on studying the influence and the sensitivity of the implant features: thread-pitch, -depth, -width, -helix angle, among others. Understanding these factors and applying them appropriately in the science of dental implants can help in reducing the potential implant failure.
An appreciable overview of the effects of implant geometrical features on osseo-integration was reported in . Authors pointed-out that a valid and valuable support in clinical and in vivo/vitro investigations is offered by numerical FEA simulations. In these terms, when facingout analyses of sensitivity on different design setting, FE modelling becomes a valid support. Many studies, mainly based on FEM approaches, have been conducted to study the influence of different design implants. A valid contribution was done in , where by using a parametric FE model the sensitivity of thread pitch and width was studied. A very interesting research was conducted by , who concluded that the most favourable configuration, in terms of implant stability, is the singlethreaded one, followed by the double threaded. The triple threaded was found to be the less stable. One critical aspect to consider is how to "quantify" the stability of a dental implant. In  authors used the contact area as measure of the stability. They found that higher the contact area, less the bone damage. A more quantitative approach was suggested in , where the implant failure was associated to the maximum normal stress criterion. Experimental tests were also conducted to measure the ultimate bone strength. In agreement with a number of studies  the von Mises stress field was used as an indicator of the average stress level at the bone-implant region, providing a global measure of the load transfer mechanism. Very often, FE models have been generated under some assumptions. Over all, 2D axial-symmetric models have been widely adopted since they allow to reach fast and accurate results and to perform quite easily
By statistically analysing numerical results. 1 Design factors and their levels Treatment ID I II III IV V VI VII VIII IX X p 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 w 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 t 1 2 3 4 2 1 4 3 3 4 1 2 4 3 2 1 α1 1 2 3 4 3 4 1 2 4 3 2 1 2 1 4 3 α2 1 2 3 4 4 3 2 1 2 1 4 3 3 4 1 2 LI α1 α2 p t w Lt XI XII XIII XIV XV XVI Tab. 2 Implant design factors June 15th – 17th.00 20. they are not able to rightly capture some phenomena which may arise at boneimplant interface. This assumption approximates a type II bone quality .95 1. The following hypotheses were formulated: the abutment is "rigidly" connected to the implant. The implant model was parameterised by introducing the following geometric parameters (see fig. Venice. 2011. In order to assure the right correspondence at boneimplant interface.P. respectively). cortical bone The bone structure was modelled by a cylinder block (diameter and length equal to 15 mm and 20 mm. By adopting a DOE approach.00 10.40 0. 1 depicts the so-modelled implant/bone geometry.00 α1 (°) 5.00 10. level/factor 1 2 3 4 p (mm) 0. perfect osseo-integration is accounted. Franciosa and M.10 w (mm) 0. Final numerical results will not be affected by this assumption since the main aim of this study is performing a sensitivity analysis among different implant features (not varying the bone geometry). Its length is Li-Lt. First of all. a single threaded implant is considered.45 0. by defining domain settings and boundary conditions. the abutment is joined to the implant with an internal screw (not modelled here). Apart from the advantages of 2D axial-symmetric models. accounting both perfect and not. and. and. In fact. a boolean operation was performed. by subtracting the implant from the bone structure. the present paper investigates the influence of some implant features. dI Tab. Fig.00 1. The cortical bone thickness was assumed constant and equal to 2 mm.10 0. 1 Bone and implant CAD models Although accurate detailed anatomical geometry may be obtained from CT scans. different implant designs were automatically generated and for each of them a FE solution was obtained.00 implant trabecular bone Fig. 2 Adopted fractional factorial array L16 Fig.20 α1 (°) 5.00 30. as also suggested into . The occlusal load is applied on the upper surface of the abutment. a 3D parametric CAD model of a dental implant was developed. Commercial solutions provide both cylindrical or conical implant. 1) was created into SolidWorks® 2010 (by Dassault Systemes) CAD system.15 0. thread-pitch ("p"). In the present research a cylindrical shape is assumed.35 0.00 20. a FE model was created. the loading mechanism can be strongly affected by screw-helix angle and also by out-ofplane stress components . a parametric CAD model of a dental implant (fig. Notice that for some commercial solutions . 2): diameter ("dI") and length ("LI").00 30.50 t (mm) 0.90 0. a simplified bone geometry was here accounted. Starting from the literature review. Notice that the thread-angle is the angle between a face of a thread and a plane perpendicular to the longitudinal axis of the same implant. -width ("w"). -tick ("t").05 0. Martorelli Studying the influence of thread features in osseo-integrated implants parametric analyses. In .perfect osseo-integration. Then. authors used a 2D axialsymmetric model to point-out the difference among different commercial design. the most influencing implant features were observed and discussed. 2 Materials and methods In order to quickly analyze different design settings. upper (α1) and lower (α2) thread-angles. Italy In the present paper we aim to study the sensitivity of 715 Proceedings of the IMProVe 2011 . bone-implant interface length (Lt). the implant diameter is assumed constant and equal to dI=4 mm. the mechanical behaviour of the bone structure is captured with a linear isotropic law.
3. 3 FE model and boundary conditions b . while the number of mesh nodes was 34174. Therefore. t. since it is reasonable that only main effects or two-factor interactions are significant. The remaining degrees of freedom correspond to three-factor and higher interactions.5a. I II III I V V VI VII VIII IX X XI XII XIII XIV XV XVI Tab. where the highest stresses are expected. the proposed approach may be summarized as follows: (I) generate a set of combinations of design factors by using a DOE approach. 2011. in this array design only 5 of the 1024 degrees of freedom  correspond to main effects. The total number of elements was 148102. 3 Implant designs generated according to the fractional factorial array L 16 Fig. Notice that if on one hand this array requires only 16 tests. five design factors were considered: p. L16. Materials were considered linear and isotropic.b and 3. and. 3. 1 reports adopted levels (shortly named "1". Italy .P. 2 reports the adopted L16 array. However. a fractional design array. Venice. then. FEM simulations were performed within Comsol Multiphysics® 3. Tab. the number of degrees of freedom solved for was 102522. α1 and α2. Same domain settings and boundary conditions were applied for the 16 geometry configurations. (II) calculate the stability index for every combination by solving a FE model. Therefore. ν . "2". Implants and abutments were assumed to be made of a titanium alloy (Ti 6Al-4V).c.bones interface Therefore. w. lower the implant stability. higher the maximum stress at bone-implant interface. according to the L16 array and generated into SolidWorks® CAD system. and only 10 degrees of freedom are related to two-factor interactions. starting from the parametric CAD model. 3 depicts the FE model related to geometry configuration III.1 mm) around implant-bone interface.Poisson's ratio). 3 depicts implant geometry configurations. 716 Proceedings of the IMProVe 2011 June 15th – 17th. Boundary conditions are depicted into figs. fig. looking for the influence of design factors. Tab. As example.a notice how mesh size was strongly reduced (about 0. Linear shape functions were adopted to interpolate node displacements. Tetrahedral mesh elements were generated.FE model c . In the following such a criterion will be named "Implant STability index" (I-STI). 4 summarise adopted mechanical properties (E . on the other hand aliasing effects may arise. For this purpose we assumed that a qualitative measure of the implant stability can be obtained by evocating the maximum stress criterion: that is. (III) analyze design scenarios. was adopted.Young's Modulus.bone-implant interface a . Among geometric parameters. Looking at fig. A full factorial design would require a large amount of 5 tests (4 = 1024). Tab. Franciosa and M. Tab. "3" and "4"). Martorelli Studying the influence of thread features in osseo-integrated implants some thread features (here called "design factors") on implant stability.
00 1.50 t 0. local overloading at the trabecular bone occurs when σT and/or σC (in modulus) exceed 5 MPa.00 0.10 10. The maximum stress criterion was implemented as follows: (I) stress distributions were calculated by using the FE model.07 0.00 20. and in tension when the maximum tensile principal stress (σT) exceeds 60 MPa.20E+00 3.95 0.65E-02 0.stability index for cortical bone Fig.45E-01 I. Franciosa and M.90 0.10 1.b and 3. 4 Mean effects of stability indexes for trabecular and cortical bones (main factors) June 15th – 17th.16E+00 1.cortical bone (mm3) 1.06 0.90 0.0 13.00 0.95E-03 3.23E-02 5.00 5.50 ν 0. 5 reports I-STi indexes calculated for trabecular and cortical bones.34E-02 6.00 0.45 0.40 0. The implant stability index can be easily implemented and calculated into Comsol Multiphysics® by using domain expressions and integration coupling variables.90 0.08 0.00 0.00 5.00 0. Moreover.10 20.00 0.00 30.20 0.00 0.00 0.43E-02 5.00 20.P.00 30.00 20. In agreement with the maximum normal stress criterion (also known as Coulomb criterion).10 1. Italy 717 Proceedings of the IMProVe 2011 .59E-02 3.00 10. principal stresses were used at the bone-implant interface to define a measure of the implant stability.00 20.35E-02 8. of design factors.10 w 0. a static load (350 N).45 0. Moreover.45 0. 2011.95 0. Martorelli Studying the influence of thread features in osseo-integrated implants The lower surface of the trabecular bone was fixed.95 1.05 10. and (III) the corresponding volume was calculated: this is the implant stability index (ISTI).33 0. Experimental tests  estimated that local overloading at cortical bone occurs in Treatment ID I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI p 0.00 0.40 0.00 compression when the maximum compressive principal stress (σC) exceeds 30 MPa (in modulus).00 1. E (GPa) Implant Cortcal bone i Trabecular bone 120.60E-02 5.05 α1 5.15 20.00 10. 4 Adopted mechanical properties  The physical interaction of implant-bone and cortical bone-trabecular bone interfaces was captured by introducing identity pairs (coloured surfaces into fig.00 Tab.95E-02 1.07E-02 2. was applied at the upper surface of the abutment.7 0.00 0. Venice.00 1.15 30. This force formed an angle of 12° with respect to the implant axis.00 30.15 5.10 0.05 20. 3 Results Tab.65E-02 1.30 Tab. Fig.39E+00 6.00 1.05 a .01E-02 1.c).50 0.99E-02 7.82E+00 4.I trabecular bone (mm 3) ST 5. 5 Fractional array L16 and implant stability indexes 2.45 0.00 α2 5. where the maximum principle normal stress exceeds the ultimate bone strength. Identity pairs assure that the displacement field at interfacial surfaces are identical each-other.47E-02 8.10 30.30 0.20 10.31E-02 7. simulating the occlusal force.72E-02 8.35 0.15 10.00 0.I cortical bone (mm 3) ST 8.00 I-ST .19E-03 2.00 0. (II) The region.24E+00 1.00 0.50 0. 3.46E-02 4.10 1.20 5.trabecular bone (mm3) 0.00 5.00 0. I.09E-02 8.00 10.40 0.71E-02 3. 4 depicts mean effects.stability index for trabecular bone b .00 5.95 0.60 1. both for trabecular and cortical bones.00 10.40 0.35 0.05 30.02E-01 1.90E-02 2.20 20.09 I-ST .00 30.35 0.40 0.20 30.03E-02 4.34E-02 7.90 0.80 0.62E-02 7.35 0. was identified.31E-02 2.50 0.
B.C. seems to play a very significant role on implant stability: its contribution index becomes 29% and 31% with respect to trabecular and cortical bone. Shang-Chih. 29 (2002). when adopting the level "4".J. Martorelli Studying the influence of thread features in osseo-integrated implants Contribution Index (%) . Experience from a 10-year period.cortical bone p w t Factor α1 α2 30% 30% 20% 20% 10% 10% 0% 0% p w t Factor α1 α2 a . Journal of Oral Rehabilitation. 229–236. J. contribution indexes were calculated. Adell. and.J.  H. 565–574.H. Xu. 5 and 6 depict contribution indexes and their cumulative values.C. variations of pitch and angle α1 do not influence implant stability. bone integrity.J. (2010). Ku. Ping-Yuen.trabecular bone 40% Contribution Index (%) .B. Chung.R. Lee. Looking at fig. Journal of Oral Implantology. S. Peng. Venice. L. Highest contribution indexes correspond to the most significant design factors. 5 Contribution indexes b .C.P. Heo. J. t. Geng. J. respectively. Han. findings showed the following key issues: thread-width and -tick play a significant role in implant stability. contribution index quantifies the influence of each design factor with respect to the implant stability index. I. Figs. H. F.W. H. when considering the cortical bone. Ma. Finite element analysis of an osseointegrated stepped screw dental implant. 223–233. this result shows that interactions among factors may arise. Tan. 129–136.cumulative contribution indexes for trabecular bone b . Wang. 16. Chia-Chin. design factors may be correlated each-other. Journal of stomatology. For instance. 6 Cumulative contribution indexes By statistically analyzing data through a Pareto ANOVA . Lee.cumulative contribution indexes for cortical bone Fig. w. D.b (cortical results) one should observe that mean effects of thread-width and -tick seems to be positively correlated each-other. The effect of thread pattern upon implant osseointegration. respectively.H.P. Influence of helix angle and density on primary stability of immediately loaded dental implants: Three-dimensional finite element analysis. 2011.P. Ming-Jen. 21. Instead. Baik. Kim. In particular. Liu. Thread-width. Journal of Oral Rehabilitation. pp. S. Rhyu.J. Osseointegrated Implants in the Treatment of the Edentulous Jaw. Effects of implant threads on the 718 Proceedings of the IMProVe 2011 4 Discussion and conclusions Assuming a significant value of 90%. Rebaudi. when looking at the trabecular bone.contribution indexes for trabecular bone Fig. pp. 30 (2004). Evaluation of design parameters of osseointegrated dental implants using finite element analysis.J. 42 (2007).S. Moreover. due to aliasing effects among factors. H.L. 618–621. K. Apart from the limitations and the simplifications of the present research.K. Very interesting is the analysis of the mean effects. Choi. 35 (2008).C. R. Chung. the stability index becomes the maximum. Q.132-136. the adopted factorial design does not allows to account such a phenomena. A. C. W. both for the w and t factors. Li.Y. Cheong.Y.B. Franciosa and M. M. J. Same conclusions can be formulated when looking at the thread-tick. Branemark. Clinical oral implant research.K. angles α1 and α2 may be neglected. S. References  S. 1 (1977).  J. Y. pp. S. Han.  P. Heo. June 15th – 17th. Pagni. I. Shi.H. S. Chun. pp.H.  L. Kim. G. Liu. Italy . This finding says that variations of this design factor may strongly influence implant stability and. Lin. Hansson. J. J Plast Reconstr Surg Suppl.  P. pp. Han. D. Future improvements of this research will focus on a two-factor and higher interactions in order to deeper understand how much load is transferred from the implant to the bone tissue and what may be the optimal implant design. 4. However.  H. then. Y. Rhyu. ShuWei. Effects of implant geometry and surface treatment on osseointegration after functional loading: a dog study. pp. K.H. Abuhussein. Z. G. S. Koak.contribution indexes for cortical bone a .
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