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Biomechanics of Implant PDF
Biomechanics of Implant PDF
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
However, the vertical elements of each system have opposing characteristics. The
implant-abutment-prosthesis interfaces introduce minute degrees of flexibility as the
result of retaining screw deformation. These factors have a profound effect on the
concepts of force distribution when systems are compared and introduce the risk of
clinical failure when teeth and implants are combined in support of prosthesis
without an understanding of these fundamental differences.
Character of Force Distribution. A scientific analysis of force distribution is
statistically indeterminate1 because of variable factors that prevent quantifying
measurements. For instance, cortical and medullary bone have different elasticities.1
The attaching screws have much more deflection (flexibility) than the prosthesis
framework. The relative intimacy of interface fit of the prosthesis to the abutments
will alter force distribution.1 Cantilever force application and the geometric location
of the fixtures further alter force distribution patterns.
Force Distribution Analysis. Finite element analysis of fixture design (ie,
computer mathematical models) has shed light on the distribution of force with
various implant configurations.4 However, Brunski3 has pointed out the enormity of
the problem when considering all of the variables involved in the evaluation of the in
vivo total prosthesis-implant-bone system. In the absence of quantified force
analysis, clinically pertinent estimates of force distribution in natural teeth and
fixture-supported systems may be made1 with simplified models2,5 and/or simplified
assumptions.6,7 Simplified approximation of force distribution is an essential first
step in diagnosis and treatment planning; the following discussion is made within the
parameter of these limitations.
Definitions
Macromovement. Movement of a tooth or prosthesis component more than 0.5 mm
and easily observable.
Micromovement. Movement of a tooth, prosthesis, or implant system
component 0.1 to 0.5 mm and not readily observable but subject to measurement.
Micron-movement. A term (coined here) to describe angstrom level
(microscopic) movement below 100 m (less than 0.1 mm) that is not observable or
subject to measurement in vivo by ordinary means.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
buccal cusp incline, the resultant line of force, perpendicular to that inclination, falls
at a great distance (D) from the center or rotation of the tooth6,7 (Fig 1a).
Torque. Lateral force is expressed as torque, which is the force multiplied by
the perpendicular distance from the center or rotation (Fig 1a). As shown in Fig 1b,
lateral force can be effectively diminished by reducing the cusp inclination of the
impact area so the resultant line of force passes closer to the center of rotation of the
tooth. Compressive and tensile forces are exerted on the periodontal ligament as the
tooth exhibits micromovement about the center of rotation (Figs 1a and 1b). The
length of the root significantly enhances the distribution of force to the alveolar
bone.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
of the vertical overlap of the incisors. High levels of torque are produced on the
retaining screw (FxD). Optimal implant orientation, as well as a therapeutic
alteration in occlusal impact area (discussed later), effectively reduces torque.
The resultant line of force can be redirected more vertically by altering the
occlusal impact area to provide a horizontal stop (Fig 2b). The resultant line of force
is more in line with the implant orientation and its supporting bone, thus effectively
reducing torque on the retaining screw and alveolar bone. In general, the location
and impact area (inclination) should be given serious consideration in the restorative
phase of implant-supported prostheses. The favorable force distribution associated
with splinted natural teeth6,7 (resulting from the micromobility of natural teeth) does
not apply to multiple-implant-supported prostheses. The micron-mobility of
osseointegration (less than 100 m) tends to concentrate force distribution in the
area of force application.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
distribution of force along the surfaces of natural tooth roots around the center of
rotation in the apical third. An osseointegrated implant has no equivalent
micromovement; therefore, the forces are concentrated at the crest of the ridge.
Torque can be reduced on the implant by creating true cusp-to-fossa occlusal
relationships and/or decreasing the inclination of the occlusal impact area. Alteration
of the occlusal relationship (such as a cross bite) provides contact more in line with
the implant rather than lateral to it. Lateral eccentric contact on a posterior
implant-supported prosthesis should be eliminated when possible. The vertical level
of implant location is dictated by anatomy. The greater the implant-occlusal
distance, the more torque is produced on the crestal bone.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
be discussed later. When occlusal impact force is exerted on the middle tooth of the
implant-supported prosthesis, similar to a natural tooth splint shown in Fig 5c, the
lingually inclined resultant line of force distributes most of the force to the crest of
alveolar bone of the middle implant (arrow, Fig 5e) with little distributed to the
adjacent implant sites.
Micromovement and Force Distribution. The same principle is applied to
multiple-implant-supported prostheses that is applied to a single implant; namely, in
the absence of micromovement provided by the periodontal ligament, there is no
effective force distribution to multiple implants in the same prosthesis. This is
because the prosthesis is stiff (rigid) and the implants and bone have only
micron-movement, which is not great enough to effectively distribute force to all of
the implants. However, multiple-fixture force transmission can take place because of
the deformation of retaining screws1,2 and possible overload caused by poor
interface fit between prosthesis and abutments.1
Retaining Screw Deformation and Stress Distribution. Because of their
reduced size and metallurgical composition, the abutment and prosthesis retaining
screws permit more deflection (flexibility) than other members of the total
prosthesis-fixture-investing bone system. Whatever force transmission takes place
between multiple implants finds its origin in the deformation (flexibility) of the
retaining screws.1,2 However, this is extremely difficult to quantify on multiple
abutments.3
Rangert et al2 found that retaining screw deformation permitted 100-m
(0.1-mm) vertical depression of a natural tooth that was splinted to a fixture on an
experimental model. It is debatable whether 100 m of vertical movement is enough
to distribute clinically significant force to the periodontal ligament. Certainly 100
m of lateral movement is not enough to distribute force to the periodontal ligament,
because "normal" tooth movement is in the range of 0.5 mm (previously defined in
this text as micromovement, which distributes stress).
Modulus of Elasticity of the Gold Retaining Screws. Gold retaining screws
are not rigid. This can be demonstrated by screwing a rigid multiple-implant metal
ceramic-casting into place with different patterns of gold screw tightening. Changes
occur in the abutment/gold coping interface not because the rigid metal ceramic
material flexes, but because the gold screws can elongate. Gold screws are,
therefore, the most "flexible" portion of the system and permit enough
micromovement to distribute force (to the fixtures). However, as demonstrated by
the Rangert et al2 experiment, the magnitude of the deflection of the retaining screws
(abutment and gold screws) is in the extreme lower end of the range of
micromovement, defined here as 0.1 to 0.5 mm. Pending three-dimensional finite
element analysis of multiple-fixture-supported prostheses, it is unknown at what
micron deflection range force transmission will be effectively transmitted to all
fixtures.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
For example, lateral force applied to the firm posterior abutment (arrow, Fig 9a)
initiates a rotation about the center of rotation located approximately in the firm
canine on that side. However, the lateral force is distributed to the remaining firm
teeth only, with very little to the more mobile premolar teeth included within the
splint because of their high differential mobility (Fig 9a).
Mobile Terminal Abutment. Mobile terminal abutments create special
diagnostic and clinical problems because of the high differential mobility between
the abutments and their strategic location. As shown in Fig 9b, when the terminal
abutments of splinted teeth have a high differential mobility, lateral force (arrow)
initiates a rotation about the firm canine on that side, as shown in Fig 9a. However,
the mobile terminal abutment creates a lever arm mechanical advantage that can
cause a metallurgical failure of the prosthesis, loosening of the castings on the
anterior teeth, and /or periodontal breakdown of the firm anterior teeth.
In summary, force transmission depends on micromovement. Differential
mobility between natural tooth abutments distributes forces disproportionately to the
firm teeth. Mobile posterior abutments within a multitooth splint can cause lever arm
overload forces on the strong anterior abutments.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Summary
Force distribution between members of a system depends on a complex relationship
between the relative stiffness of the structural parts with its investment medium
(periodontal ligament or osseointegration). A rigid prosthesis is necessary to
distribute force in all types of multiple-unit-supported prostheses. When force is
applied to one portion of a multiple-tooth-supported prosthesis, the micromovement
of the periodontal ligament (0.5 mm range) initiates movement of the whole rigid
structural entity (teeth and prosthesis). This micromovement distributes force to the
remaining natural teeth.
With a multiple-implant-supported prosthesis, force application to one portion is
distributed to the nearest osseointegrated fixture interface. The force is concentrated
at that interface. The amount of distribution to the remaining fixtures depends on the
degree of deformation (flexibility) of the investing bone, fixture, abutment, retaining
screws, and prosthesis. The range of deformation of the most flexible part of the
system (the retaining screws) is at the lower end of micromotion (in the range of 100
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
m). Therefore, the amount of force distribution to the remaining fixtures is much
less than that found with a periodontal ligament, which can permit 0.5 mm of
movement (500 m).
Paradoxically, because of the relative "flexibility" of the periodontal ligament,
force distribution is dependent on a rigid structural entity of teeth and prosthesis.
Conversely, because the osseointegrated interface permits no movement, force
distribution depends on some deformation of the fixture-abutment-retaining screw
complex.
Combined prostheses using implants and natural teeth should be approached
with caution. Internal attachments and/or telescopic coping construction have been
used. However, force transmission is completely different in both segments.
Implants always support the natural teeth, rather than visa versa, because of the
overwhelming differential in mobility between periodontal ligament micromovement
and the osseointegrated implant interface. New design principles have been
recommended to avoid implant overload.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 1a to 1d
: Comparison of torque production in natural and implant-supported prostheses relative
to changes in cuspal inclination. O = vertical occlusal force; F = resultant force; CR =
center of rotation; D, d = distance; T = torque.
Figs. 2a and
2b : Modification of the anterior impact area can reduce torque. F = resultant force; D =
distance; T = torque.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 3a and
3b : Location of the impact area more in line with the implant can reduce torque
(posterior cross bite, right). O = vertical occlusal force; F = resultant force; D = distance;
T = torque.
Figs. 4a and 4b
: Vertical level of the implant can influence torque production (left). When the implant is
severely inclined (right), the increased vertical level of the residual bone can exaggerate
torque production. O = occlusal impact area; F = resultant line of force; x, y, z =
increasing distance of line of force to crest of ridge; X, Y, Z = torque increases as the
crest of the ridge is located more apically.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 5a to 5e :
Comparison of force distribution with a natural tooth splint compared to an
implant-supported prosthesis. F = resultant line of force; CR = center of rotation; O =
occlusal force.
Figs. 6a and
6b : Gold screw micromovement permits force distribution (left). Lateral force produces
structural shear Stress on all the components (right). O = occlusal force; F = resultant
line of force.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 7a and
7b : Interface fit affects shear stress on gold retaining screws. F = force application.
Figs. 8a and
8b : The location of vertical force changes the force distribution to the implants. O =
vertical component force.
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 9a and
9b : When the terminal abutment of a prosthesis is firm, the weak included teeth are
mutually supported (left). A mobile terminal abutment produces a lever arm that can
overcome strong anterior teeth (right). R = center of rotation; II = Class II, macromobility;
I = Class I, micromobility.
Figs. 10a
and 10b : An internal attachment with a U-shaped pin can prevent vertical separation
( left). A telescopic coping can be used to combine natural teeth with a fixed-retrievable
implant-supported prosthesis (right).
JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Figs. 11a
and 11b : A long lever arm is produced when an implant-supported prosthesis is
cantilevered to a natural tooth prosthesis (left). Less torque is created if cantilevers are
extended from both prostheses and joined with an internal attachment (right).