Dept.

of Materials Science & Engineering

Spring 2020

MTSE 4020: Materials in Medicine

Literature Review

Due date: Wednesday, 4/15/2020.

Requirements:

Literature Review:
Choose one of the two papers attached and write a review paper. Minimum five pages, double
space. Submit the review to Canvas.

Review should be written in paper form, including title, abstract, introduction, review main body,
conclusion and references. You can select your own paper, but the paper should be relevant to
computational materials (techniques taught in the classes). The detailed requirement and format
for review report are described as follows:

Title

Abstract

Introduction: Explain why the authors were interested in the topic and the specific
computational method.

Review main body: i)The computational methods and procedures, compare the computational
methods with those learnt in the class; ii) main results that the authors got from the computation,
comments on results, and iii) suggestions on improvement of the paper and future work

Conclusions: Your overall comments on the paper

References: list literatures you cited

 The First Paper
K N et al., Cogent Engineering (2020), 7: 1719575
https://doi.org/10.1080/23311916.2020.1719575

BIOMEDICAL ENGINEERING | RESEARCH ARTICLE

Received: 07 November 2019
Accepted: 17 January 2020
*Corresponding author: Shenoy
B Satish, Aeronautical and
Automobile Engineering Department,
Manipal Institute of Technology,
Manipal Academy of Higher
Education, Manipal, India
E-mail: satish.shenoy@manipal.edu
Reviewing editor:
Duncan Shepherd, University of
Birmingham, UK
Additional information is available at
the end of the article
Optimized trapezoidal-shaped hip implant for
total hip arthroplasty using finite element
analysis
Chethan K N1, Mohammad Zuber1, Shyamasunder Bhat N2 and Satish Shenoy B1*
Abstract: Hip implants consist of a stem, femoral head, acetabular cup, and
backing cup. There is a wide variety of sizes and lengths. Their adaptability is limited
because of the inter-anatomical variations. There is no single fit-for-all implant
design that satisfies the orthopedic requirement satisfactorily. In this work, the
trapezoidal-shaped stem with three different cross-sections is considered. The
femoral head size, acetabular cup thickness, backing cup thickness, and trunnion
geometry were varied to arrive at the best possible combination. ANSYS R-19 was
used to perform the static analysis. It is found that trapezoidal-shaped profile two
has the least amount of stress and total deformation. The von Mises stresses were
found to be higher when the femoral head size was between 32 mm to 40 mm in
profile two. It was also observed that the femoral head with 24 mm has the least
stress compared to higher head sizes. The maximum von Mises stress-induced in
profile two was 141.0 MPa, the total deformation of 0.04436 mm and elastic strain
of 7.6 × 10−4 mm/mm. Trunnion interface does not have a significant role with
respect to the structural strength of the implant. From the findings of this study, it is
inferred that profile two shaped stems with the femoral ball size of 36 mm, acet-
abular cup thickness of 2 mm and backing cup thickness of 1mm is best suited for
the hip replacement. The major outcome of this study is the utilization of the DoE
method to determine the optimized value of the implant.

ABOUT THE AUTHOR PUBLIC INTEREST STATEMENT

Chethan K N has been working as an Assistant
Professor in the Department of Aeronautical and
Automobile Engineering, Manipal Institute of
Technology, Manipal Academy of Higher
Education, Manipal, Karnataka, INDIA. His area of
interest includes Biomechanics of the hip joint,
Finite element analysis of biomedical implants,
Composite materials, and Manufacturing of
medical implants. The author has published arti-
cles related to finite element analysis of hip
implants, mechanical characterization of materi-
als and composite materials.
Chethan K N
Total hip replacement is one of the main
advancements in health care. These implants as
a service of fifteen to twenty years. After the life
of implants, patients have to undergo revision
surgery, which is again costly and timeconsum-
ing procedure. Hence there is a need to increase
the life expectancy of such implants.
In the current work, three different profiled
trapezoidal-shaped hip implant is used to evalu-
ate a good stem design. It is also considered
varying key design features like femoral head,
acetabular cup, and backing cup to know the
ranges at which these implants perform signifi-
cantly.
This paper provides insight into novel hip
implant design and analysis using the FE techni-
que and design of experiment.

© 2020 The Author(s). This open access article is distributed under a Creative Commons
Attribution (CC-BY) 4.0 license.

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Subjects: Mechanical Engineering Design; Structural Mechanical Engineering; Joint

Replacement; Prosthetics & Orthotics

Keywords: Hip joint; finite element analysis; design of experiment; deformation; von Mises
stress; total hip arthroplasty

1. Introduction
Nowadays biomedical implants have gained significant traction for improving the quality of life
(Bhat & Kumar, 2013). Total hip arthroplasty is one of the techniques used from way back from the
early 19th century to replace the hip joint due to fractures or due to osteoarthritis(Gomez &
Morcuende, 2005). It is popularly known as one of the best-advanced techniques in the health
care of the 21st century(Chethan, Satish Shenoy, & Shyamasunder Bhat, 2018). The hip joint is
a synovial joint connects the lower limb to the trunk and is the largest weight-bearing joint next
only to the knee joint. It is composed of femur bone consisting of the femoral head which
articulates into the acetabulum of the pelvic girdle(Chethan, Zuber, Bhat, et al., 2019a). The
average length of adult hip bone being 45cms which is approximately ¼th of adult height(Pan,
1924). Hip joints assist in the transfer of load from the upper body to the lower abdomen (Jun &
Choi, 2010). Its provision for various degrees of freedom namely flexion, extension, abduction,
adduction, internal rotation, external rotation facilitates human movement such as jogging, run-
ning, walking(Mathukumar, Nagarajan, & Radhakrishnan, 2019). A natural hip joint is shown in
Figure 1.

The healthy femur bone can withstand ten times to its body weight, beyond which it can lead
to fracture(Chethan, Bhat, Zuber, & Shenoy, 2019). The total hip arthroplasty consists of
implants made up of the stem, femoral head, acetabular cup and backing cup where the
stem is inserted into the femur and femoral head is fitted over the stem by press-fit mechan-
ism(Mattei, Di Puccio, Piccigallo, & Ciulli, 2011; Ihesiulor, Shankar, Smith, & Fien, 2015). The
replaced hip joints are made up of biomaterials that comply with patient requirements.
Currently, titanium-based alloys, chromium-based alloys, and ultrahigh molecular polyethylene
are used widely used to manufacture these implants(Saini, 2015). The implants are usually
patient specific which depends on the length of the femur, the diameter of the femoral head
and the angle between femoral head to the femur. The size of the femoral head can vary from
22 mm to 54 mm depending upon specific human anatomy(Cho, Choi, & Kim, 2016). The
femoral stems are available in many different geometrical designs such as straight, tapered,
short length, and anatomical(Levadnyi, Awrejcewicz, Gubaua, & Pereira, 2017; Kim & Yoo,

Figure 1. The natural hip joint

(right hip). (a) Capsule removed
anterior aspect, (b) showing the
ligament. (Chethan et al., 2018).

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2016). It has been reported in the various literature that these implants can last for ten years
and less due to the extensive wear of materials (Watanabe et al., 2000; Huiskes & Chao, 1983;
Rohlmann, Mössner, Bergmann, & Kölbel, 1983).

The inter-human anatomical variations make it extremely difficult to identify experimentally the
correct combination of implants and material combinations. Several studies have popularly
employed state-of-art Finite element analysis to evaluate implant designs with respect to load
carrying capacity and geometrical modifications (Watanabe et al., 2000; Huiskes & Chao, 1983;
Rohlmann et al., 1983). (Chethan, Zuber, Bhat N., et al., 2019) carried out an FEA study to evaluate
the hip joint designs by using circular, ellipse, oval, trapezoidal designs. (Jiang, 2007) investigated
four different structural models of artificial joints made of ultra-high molecular weight polyethy-
lene (UHMWPE), CoCrMo alloy, 316L stainless steel, and Ti-6Al-4V alloy and their mechanical
characteristics under static and dynamic conditions are investigated using finite element method
(FEM). They have considered the femoral head of 28 mm diameter and acetabulum of thickness
8 mm. (Senalp, Kayabasi, & Kurtaran, 2007) investigated the static, dynamic and fatigue behavior
of Ti–6Al–4V and cobalt-chromium metal materials and compared with stem shape developed by
Charnley. (Yan, Berthe, & Wen, 2011) studied the effect of a porous titanium femoral prosthesis on
bone remodeling. In another study, (Bah, Browne, Young, Bryan, & Xuan, 2011) applied joint
reaction force acting on the greater trochanter and the load on the center of the femoral head.
(Horak, Kubovy, & Horakova, 2011) utilized the force and kinematic conditions to develop the hip
joint computational model.

The major issues with femur implant modeling and experimentation are the lack of standardiza-
tion which makes comparison very difficult. Most studies only focused on changing the geometrical
shapes and considered the loads lesser than ten times of body weight. Very few studies have
adopted the ISO 7206–4:2010(E) and ASTM2996-F13 standards which provide specific guidelines to
formulate boundary conditions and loads with respect to the length of the implant. The studies
have reported different sizes of the femoral head, acetabular cup and backing cups being used
(Chethan, Zuber, Bhat N., et al., 2019b). Moreover, there are many disagreements on the shape of
the implant, material considerations and geometrical requirements (Kim & Yoo, 2016; Gabarre,
Herrera, Ibarz, Mateo, & Gil, 2016). Our earlier works have shown that the trapezoidal-shaped
implant made up of CoCr shows the best outcomes in terms of von Mises stresses (Chethan, Zuber,
Bhat N., et al., 2019).

In the present study, a trapezoidal-shaped implant is designed with three different cross-sections
and optimization of the design is accomplished using the design of the experiment [DOE] feature of
Ansys R-19. The parameters varied were femoral head diameter, acetabular cups [liner], and backing
cups [Shell]. In hip implant the stem remains the same, however, the femoral head size, liner
thickness, shell thickness are varied as per the anatomy of the patient. So, in this study, a wide
range of these parameters are considered to arrive at the best-suited stem profile with the optimum
size of head, shell, liner which can be expected to have an extended life span.

2. Material and methods

The trapezoidal-shaped stem of length 180 mm is designed using CATIA V-6. Three different cross-
sections “Profile one, Profile two & Profile three” with varying stem curvature is designed as shown in
Figure 2. Profile one consists of a straight stem with the lateral side near the proximal end provided
with a specific radius. In the case of Profile two, the diameter and arc length increases with an
increase in the total angle between the lateral and medial side of the stem. Whereas, the profile
three has the radius on the lateral side being completely removed and replaced with the cornered
shoulder. In all the three profiles considered the neck and medial side dimensions remain constant.

The femoral head, liner, and shell are kept constant for all the three stem models varying in
cross-section. The trunnion is the taper junction into which the ball is attached with press-fit(Derar
& Shahinpoor, 2015; Nassif et al., 2014; Bishop et al., 2013). Usually, this trunnion will be 12/

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Figure 2. (a) Three different

cross-section designs of trape-
zoidal stems. (b) Illustration to
demonstrate the trunnion for
example, in a “12/14” taper.

i. ii.

14 mm. The cross-section of the taper trunnion is shown in Figure 2(b). Where 14 mm diameter at
the bottom of the neck and 12 mm diameter at the top of the neck. The factors that affect the
design performance of hip implants are the thickness of the liner, shell thickness, femoral head
diameter, and the trunnion design. The femoral head diameter varies from 24 mm to 44 mm, the
liner has a thickness from 2 to 10 mm, whereas the shell has thickness range from 1 to 4 mm
(Saputra, Anwar, Jamari, & Van Der Heide, 2013; Tsikandylakis et al., 2018; López-López et al.,
2017). These variations are necessary to accommodate the different anatomical considerations
and cater to patient-specific requirements.

In this work, the trunnion bottom surface radius is kept constant at 7 mm and the top surface
radius is varied from 3 mm to 6 mm at an interval of 0.5 mm. The boundary conditions are applied
as per the ASTM2996-F13 standard and loading conditions considered are as per ISO 7206–4:2010
(E) (ASTM, 2015). Table 1 shows the key performance indicators which are considered for the static
structural analysis carried out in this work. The results are analyzed to determine the best profile
and identify the least stress-bearing design for the given boundary conditions.

This is made possible by the design of experiments [DOE] approach of Ansys R-19. In this work,
CoC [ceramic on ceramic] is considered due to its excellent stress-bearing abilities and deforma-
tion (Chethan, Zuber, Bhat N., et al., 2019). Where all the components are considered as ceramic
and the properties of the material of CoCr are given in Table 2.

Table 1. Different sizes of backing cup, acetabular cup, femoral head and trunnion top surface for
the trapezoidal-shaped implant (Goebel et al., 2012) (Al-hamad, Duff, Takamura, & Amstutz,
2014) (Liu, Jin, Roberts, Grigoris, & Hospital, 2015)
Sl no. Backing Cup Acetabular cup Femoral Head Trunnion top
(Shell) (liner thickness) surface radius
1. 1 mm 2 mm 24 mm 3 mm
2. 2 mm 4 mm 28 mm 3.5 mm
3. 3 mm 6 mm 32 mm 4 mm
4. 4 mm 8 mm 36 mm 4.5 mm
5. - 10 mm 40 mm 5 mm
6. - - 44 mm 5.5 mm
7. - - - 6 mm

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Table 2. Mechanical properties of CoCr material (Palla, Group, & Gurunathan, 2011)
Sl Materials Young’s Density [gm/ Poisson’s Ultimate
combination modulus cm3] ratio Tensile
[GPa] strength
[MPa]
1. CoCr alloy 200 8.5 0.30 1503

Figure 3. (a) Variation of the

stress values with a change in
mesh size; (b) Boundary
Condition Location for Hip Stem
Length of 120 mm < CT <
250 mm (ASTM, 2015).

The mesh convergence study resulted in a 1 mm size mesh as the most suitable for unstructured
mesh, with no significant changes in the results with mesh size lesser than 1 mm. Figure 3(a) shows
the mesh convergence for the von Mises stress. The total number of nodes & elements obtained is
678,328 and 516,897 respectively.

2.1. Boundary conditions

The boundary conditions are applied as per the ASTM F2996-13 and loading conditions are
considered as per ISO 7206–4:2010(E)(ASTM, 2015). The fixation of the stem and load application
is as shown in Figure 3(b). According to the standards, the modeled stems are bisected into three
cross-sections from the top surface of the stem. The hip stem is cut from the center of the head as
per the ISO 7206–4:2010(E) with the worst-case head/neck offset. The first cut is done 80 mm from
the center of the top surface for depicting the stress distribution over the implant. A second cut is
then made 10 mm below the first cut. The hip stem is constrained in all directions on all faces
distal to the second cut. Constraining the stem in this manner ensures that excessive erroneous
stresses are not generated at the region of interest due to the influence of rigid fixation. The
remaining portion about 90 mm is the fixed support and is constrained in all degrees of freedom.
Figure 3(b) shows the bisection of the model.

As per the standards, a static force of 2,300N is applied over the head of the implants. Figure 4(a)
shows the discretized model of the complete hip implant(Chethan, Shyamasunder Bhat, Zuber, & Satish
Shenoy, 2019b). Figure 4(b) shows the load applied and fixed boundary conditions as per the standards.
Static structural analysis is carried out to evaluate the von Mises stresses and total deformation.

The design of experiments is applied to the set of varying parameters to the fixed stem. The
stem is kept constant and the other components like shell, liner and femoral head sizes are varied
to know the effect of these parameters on the implants. The sizes which are considered for the
study are shown in Table 1. In previous works usually, a set of the parameter with the fixed size is
considered for the analysis, but nowhere DOE was applied to identify the best combination with

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Figure 4. (a) Discretized hip

implant model (b) Boundary
conditions applied over the hip
implant.

a change in these parameters(Geramizadeh, Katoozian, Amid, & Kadkhodazadeh, 2018; Ur, Erdem,
Haider, & Boccaccini, 2017).

3. Results

3.1. Static structural analysis of trapezoidal shaped hip implant

An initial model of the trapezoidal-shaped stem for profile one was analyzed using FEM
analysis. The analysis was carried out for the constant femoral head size of 32 mm, liner
thickness of 4 mm and shell thickness of 2 mm. The boundary conditions are applied as per the
ASTM2996-F13 and loading conditions are considered as per ISO 7206–4:2010(E). The von Mises
stress and total deformation along with elastic strain were evaluated. The total deformation
was found to be 0.059 mm, von Mises stress of 207.2 MPa and equivalent elastic strain was
0.0011 mm/mm. Figure 5 shows the total deformation, von Mises stress, elastic strain.
Although the findings were almost similar to the previous studies with different types of
boundary conditions, there is large variability in terms of geometrical parameters that are
considered. There are several types of implants of various sizes and shapes that could be
clinically used (Cho et al., 2016; López-López et al., 2017). There is no implant that could be
employed one-fit-for-all and perfectly address the safety and durability considerations. In this
work, an optimization study was carried out to (a) Study the inter-operable relationship
between the size of the femoral head and trunnion taper radius, and (b) determine the best
combination of the acetabular cup[liner] and backing cup[shell] sizes for reduced stresses and
deformation.

3.2. Effect of different sized femoral heads v/s varying the trunnion taper radius
Trunnion which is usually 12/14 mm in diameter is the tapered junction of the stem where the
femoral head resides (Baharuddin et al., 2014). In this study, the effect of different femoral head
diameter and the varying taper size is studied for profile one, profile two and profile three. The
femoral head comes with varying sizes of 24 mm to 54 mm depending upon the anatomy of the
patient(López-López et al., 2017). In this work, the models developed have the femoral head
changed from 24 mm to 44 mm at 4 mm intervals each. The shell thickness is kept constant of
2 mm and liner thickness is kept constant of 4 mm. The top surface of the trunnion was tapered
from 12 mm to 6 mm while maintaining the bottom surface at 14 mm in diameter. This resulted in
a total of 42 different possible combinations of implant designs as indicated in Table 1. Using the
DOE feature of ANSYS R-19, all the combinations were analyzed at identical boundary conditions.

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Figure 5. (a) Total deformation,

(b) von Mises stress, (c) Elastic
strain.

Figure 6. Profile one varying

with trunnion and femoral head
(a) Total deformation (b) von
Mises stress (c) Elastic strain.

Figure 6 shows the response curve for the varying femoral head size to the trunnion top surface
dimension for trapezoidal stem profile one.

The variation in femoral head size resulted in a significant change in the total deformation, von
Mises stress, and elastic strain. As the femoral head size increases there is a considerable decrease
in the deformation, stress-induced in the implant and strain rate. The maximum von Mises stress
developed was 203.0 MPa, maximum deformation was 0.0604 mm and an elastic strain of
1.06 × 10−3 mm/mm was observed for profile one. This was applicable for an implant having
a 24 mm head with a 3 mm trunnion radius. The minimum values were obtained for profile one
implant having a 44 mm head diameter and a trunnion of 6 mm taper radius.

The description of DOE findings for profile two is different from that of profile one. Figure 7 shows
the response curve for the varying femoral head size to the trunnion top surface dimension for
trapezoidal stem having profile two.

The von Mises stresses were found to be higher when the femoral head size is between 32 mm to
40 mm. It was also observed that the femoral head with 24 mm has the least stress compared to higher
head sizes. The findings were similar for the elastic strain determined. The maximum von Mises stress-

Figure 7. Profile two varying

with trunnion and femoral head
(a) Total deformation (b) von
Mises stress (c) Elastic strain.

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Figure 8. Profile three varying

with trunnion and femoral head
(a) Total deformation (b) von
Mises stress (c) Elastic strain.

induced in profile two was 141.0 MPa, the total deformation of 0.04436 mm and elastic strain of
7.6 × 10−4 mm/mm. However, there is no significant variation in the total deformation values with the
change in the trunnion radius.

Figure 8 shows the response curve for the varying femoral head size to the trunnion top surface
dimension for trapezoidal stem profile three.

In the case of profile three, the stress and elastic strains decrease linearly with the increase in
the femoral head size. The total deformation was found to be least at the head size of 36 mm and
increased with a subsequent increase in the head size. The maximum total deformation was
0.0586 mm, von Mises stress was a maximum of 172.45 MPa and the elastic strain was observed
at 8.6704 × 10−4 mm/mm. Another observation was that the total deformation was less for the
36 mm diameter femoral head.

In general, it was observed that profile two accounted for the lowest value of total deformation,
von Mises stress and elastic strain with respect to variations in the femoral head size and change in
trunnion shape. Among all the variations considered, the femoral head size of 36 mm and trunnion
radius of 6 mm produced the best outcome and was consistent with all the profiles studied.

3.2.1. Effect of acetabular cup v/s backing cups on von mises stress
For this study, the femoral head was maintained constant at 36 mm diameter, and the trunnion
was fixed at 12/14 mm. The liner and the shell thickness varied as shown in Table 1. The liner was
varied from 2 to 10 mm at an interval of 2 mm and the shell cup was varied from 1 to 4 mm at an
interval of 1 mm.

The total deformation, von Mises stress and elastic strain for profile one are shown in Figure 9.

It can be seen from the figure that the maximum total deformation of 0.0586, von Mises stress
of 199.0MPa and elastic strain of 1.038 × 10−3 mm/mm was observed with 2 mm liner thickness
and 4 mm shell thickness. The least value of deformation and von Mises stress was obtained with
10 mm of liner thickness and 4 mm of shell thickness.

Figure 9. Profile one with vary-

ing liner and shell thickness (a)
Total deformation (b) von Mises
stress (c) Elastic strain.

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Figure 10. Profile two with

varying liner and shell thick-
ness (a) Total deformation (b)
von Mises stress (c) Elastic
strain.

Figure 11. Profile three with

varying liner and shell thick-
ness (a) Total deformation (b)
von Mises stress (c) Elastic
strain.

Figure 10 shows the total deformation, von Mises stresses and elastic strain for the profile two
shaped stems. In the case of profile two, the maximum total deformation, von Mises, and elastic
strain were 0.047 mm, 142MPa, and 7.96 × 10−4 mm/mm respectively. Moreover, it was determined
that an implant with the lowest liner thickness and backing cup thickness has significantly reduced
deformation and von Mises stress.

Figure 11 shows the total deformation, von Mises stress and elastic strain for the profile three
trapezoidal stems. The maximum value of total deformation, von Mises stress and elastic strain
obtained were 0.0576 mm, 175MPa, and 8.81x10−4 mm respectively. It was also found that the
total deformation was less when 8 mm liner was used against 1.5 mm shell. However, the von
Mises stress and elastic strain recorded the lowest values when 10 mm liner is used against
a 4 mm shell.

Thus, for the case where the liner thickness and shell were varied, profile three exhibited better
outcomes when compared to the other profiles. In terms of quantifiable values of total deforma-
tion, von Mises stress and elastic strain, profile two shaped stem showcased the lowest values
overall for both the studies.

4. Discussion
Hip implants are manufactured using different types of biomaterials and are available in various
designs(Goldsmith, Dowson, Isaac, & Lancaster, 2000). The major problem with hip arthroplasty is
that it can last only for about 10 years in active younger patients. Chromium cobalt, titanium
alloys, ultra-high molecular polyethylene are the materials which are widely used in the hip
implants. Several studies have carried out design changes to improve the implants especially the
stem part(Senalp et al., 2007; Chao & López, 2007; Tanner et al., 1995). Some studies have
suggested shorter stems, and others have adopted longer stems. In some studies, the profile of
the stem was modified and analyzed(Abdullah, Asri, Alias, & Giha, 2010; Takai, Nakayama,
Murayama, & Takahashi, 2019; Spinelli et al., 2012). Mamdouh et al. considered Titanium alloy
32 mm femoral head, 15 mm UHMWPE acetabular cup along with 1 mm backing cup. They found
that stresses reduced due to the addition of backing cup(Monif, 2012). Yuan et al. studied the
biomechanical effect of unilateral hip arthroplasty and observed a maximum total deformation of
0.68 mm after the surgery(Xin, Kim, & Yang, 2013). Griza et al. considered an implant of 175 mm
length. They found the maximum von Mises stress of 285.1MPa acting on the stem when 2300N of

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the load was applied on the femoral head(Griza, Reis, Reboh, Reguly, & Strohaecker, 2008). Zanon
et al. considered the stem length of 165 mm and applied the load as per ASTM F 745 standards.
The maximum von Mises stresses of 210MPa were obtained at the lateral region of the stem(Griza
et al., 2009). Ji-Yong Bae et al. studied the effect of different cross-section shaped modular stems
along with femur bone including the pelvic. They applied a load of 1764MPa equivalent to three
times the bodyweight of women and observed. The maximum stress of 185.7MPa was reported at
the upper part of the stem and 110.0 MPa at the lower part of the stem(Bae et al., 2011).
Kayabhasi et al. studied the effect of notching in the stem design. They have considered the
femur bone along with the cobalt-chromium implant. They found the maximum von Mises stress of
193.4MPa(Kayabasi & Erzincanli, 2006). Hai-Bo Jiang et al. considered femoral head made up of
stainless steel, Ti-6Al-4V and cobalt-chromium over UHMWPE liner, they observed the maximum
total deformation 0.1 mm for stainless steel and 0.85 mm for cobalt-chromium when a load of
200N is applied over the center of the femoral head(Jiang, 2007).

In general, there is a wide range of choices in the selection of femur implants. This is further
complicated by the patient to patient anatomical variations. There is no one-fit for all implants that
can satisfy the conditions of structural strength for longer durability. von Mises stress greatly affects
the life of the implant when continuous cyclic load associated with regular day to day activities is
applied to the implant. Aseptic loosing is one of the major problems in the implants(Shi, Ajayi, Fenske,
Erdemir, & Liang, 2003; Burger, de Vaal, & Meyer, 2007). Deformation greatly affects the loosening of
the implant. Thus, in this work, trapezoidal stems with three different popular profiles were modeled
and parametric changes were carried out using the design of the experiment option in Ansys 19. The
key design features which greatly affect the implants are identified as shown in Table 1. Our previous
studies have shown that the performance of cobalt- chromium implants to be more suitable than the
other widely used biomaterials (Chethan, Zuber, Bhat N., et al., 2019).

An initial static analysis was performed for a standard femoral head size of 32 mm, liner thickness
of 4 mm and backing shell thickness of 2 mm for all the three profiles. Profile two exhibited the least
value of total deformation and von Mises stress compared to profile one and profile three. The
maximum von Mises stress, total deformation and elastic strain for profile two were 207.2 MPa,
0.059 mm and 0.0011 mm/mm respectively. The values obtained in this study was comparatively
lesser than those observed in previous literature (Jiang, 2007; Griza et al., 2009; Xin et al., 2013; Bae
et al., 2011; Kayabasi & Erzincanli, 2006). In the study of hip implant design, patient anatomy is very
vital in the choice of femoral head size, liner thickness, and shell thickness. Besides, it is difficult to
conclude whether the implants so designed are optimum enough for different sizes. Design of
experiments is a widely used method to arrive at an optimum value when several competing
variables influence the choice of design. In order to determine, the best possible design outcome,
two sets of optimization studies were carried out, (a) study the inter-operable relationship between
the size of the femoral head and trunnion taper radius, and (b) determine the best combination of
liner and shell sizes for reduced stresses and deformation. Using the DoE approach, a a femoral head
diameter was varied from 24 mm to 44 mm at an interval of 4 mm each and the liner thickness
varied from 2 to 10 mm at a interval of 2 mm and shell thickness is varied from the 1 to 4 mm at an
interval of 1 mm. It was found that all the design analysed exhibited stresses and deformation well
within the allowable design limit. Among all the profile studied, profile two with femoral head
diameter of 36 mm, liner thickness of 2 mm and shell thickness of 1 mm exhibited the lowest von
Mises stress of 139MPa. Moreover the deformation of profile two shaped stem has lowest deforma-
tion of 0.042 mm. None of the earlier studies have obtained stress value closer to the present finding
(Griza et al., 2008; Griza et al., 2009; Bae et al., 2011; Kayabasi & Erzincanli, 2006). Also, the
deformation value for the optimized implant determined using the DoE approach is lower than
any of the previous studies (Jiang, 2007; Xin et al., 2013).

5. Conclusion
The hip implant is one of the commonly and widely used surgical procedures to overcome the pain
associated with a fractured hip. The use of DoE is to evaluate different key parameters that are varied

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K N et al., Cogent Engineering (2020), 7: 1719575
https://doi.org/10.1080/23311916.2020.1719575

in the real condition and to come out with the best-suited size. Different types of stems are used with
varying designs and sizes adapting to the patient’s anatomy. In this study, three different profiles of
the cobalt-chromium stem are considered and analyzed using the design of experiment approach in
ANSYS R-19. The acetabular cup, backing cup, and trunnion top surface radius and femoral head sizes
are varied. It was observed that profile two shaped stem design has the least von Mises stress and
total deformation values compared to profile one and profile three. Trunnion interface does not play
a significant role with respect to the structural strength of the implant. The main outcome of this
study is the utilization of the DoE method to determine the optimized value of the implant. The
trapezoidal profile two with the femoral head of 36 mm diameter, 2 mm liner thickness, and 1 mm
shell thickness resulted in the lowest von Mises stress and total deformation. Further, this approach
can be applied to varying the materials used in implants. Also along with the implants, femur bone
and ligaments can also be considered for the analysis.

Abbreviations

UHMWPE Ultra-high molecular weight polyethylene

CoCrMo alloy Cobalt-chromium-molybdenum alloy
Ti-6Al-4V alloy Alpha-beta titanium alloy
FEM Finite element method
DOE Design of experiments
CoC Ceramic in Ceramic

Acknowledgements Shyamasunder Bhat N2

The authors thank the Department of Aeronautical and
Automobile Engineering, Manipal Institute of Technology,
Manipal Academy of Higher Education, Manipal for providing
the high computational facility to carry out this research.
Authors’ contributions
Chethan.K.N, Satish Shenoy B and Shyamasunder Bhat
N designed the project.
Chethan.K.N and Mohammad Zuber performed the
analysis.
Chethan.K.N wrote the manuscript.
Shyamsunder Bhat N and Satish Shenoy B gave advice on
writing article.
Satish Shenoy B, Mohammad Zuber reviewed the
manuscript.
All authors read and approved the final manuscript before
submitting it to the journal.
Consent for publication
All authors consent for the publication of this manuscript.
Ethics approval and consent to participate
An institutional ethical clearance has been obtained from
Kasturba Medical College and Kasturba Hospital’s institu-
tional ethical committee. [Registration No. ECR/146/Inst/
KA/2013/RR-16].
Funding
This research did not receive any specific grant from fund-
ing agencies in the public, commercial, or not-for-profit
sectors.
Author details
Chethan K N1
E-mail: chethan.kn@manipal.edu
ORCID ID: http://orcid.org/0000-0002-9399-685X
Mohammad Zuber1
E-mail: mohammad.zuber@manipal.edu
ORCID ID: http://orcid.org/0000-0002-5790-5009
E-mail: shayambhat.n@manipal.edu
ORCID ID: http://orcid.org/0000-0001-9545-4838
Satish Shenoy B1
E-mail: satish.shenoy@manipal.edu
ORCID ID: http://orcid.org/0000-0003-2374-3854
1
Aeronautical and Automobile Engineering Department,
Manipal Institute of Technology, Manipal Academy of
Higher Education, Manipal, India.
2
Department of Orthopedics, Kasturba Medical College,
Manipal Academy of Higher Education, Manipal, India.
Competing interests
The authors declare that they have no competing
interests.
Citation information
Cite this article as: Optimized trapezoidal-shaped hip
implant for total hip arthroplasty using finite element
analysis, Chethan K N, Mohammad Zuber, Shyamasunder
Bhat N & Satish Shenoy B, Cogent Engineering (2020), 7:
1719575.
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 The Second Paper

Finite Element Analysis in 2D and 3D Models for

Sound and Restored Teeth

Andréa B. Motta*, Luiz C. Pereira** and Andréia R.C.C. da Cunha***

*Dentist, MSc. in Oral Rehabilitation and Doctoral student of the Biomaterials Group, Department
of Metallurgy and Materials Engineering, Federal University of Rio de Janeiro, Brazil.

**DSc., Professor of the Department of Metallurgy and Materials Engineering, Federal University
of Rio de Janeiro, Brazil.

***Dentist, MSc. and Researcher of the Biomaterials Group, Department of Metallurgy and
Materials Engineering, Federal University of Rio de Janeiro, Brazil.

Abstract: Finite element analysis (FEA) was first used in Dentistry in the 70’s to replace
photoelasticity tests. Since then, many researches have been developed by association of dentists
and engineers, using 2D models. Because of the development of new image acquisition techniques
and the development of technical design program the use of 3D models has increased.
It is difficult to analyze the mechanical behavior of sound or restored teeth using laboratorial or
“in vivo” methods because many variables interplay: geometry complexity, different materials
involved and different load modes, little availability of extract teeth and patient participation. FEA
allows the creation of complex models and the analysis of each variable’s influence on a model
constructed by the researcher, which has more significant geometric elements.
The analysis already done by our group TerMic/Biomaterials from PEMM/UFRJ includes stress
distribution analysis of 2D models with different modes of load on teeth in different conditions:
sound, with an abfraction lesion, direct restoration (amalgam and composite resin) and indirect
restoration (dental crown or fixed partial prosthesis).
Nowadays our group is developing 3D models to verify the volumetric/geometric implications in
results. Sound and abfraction teeth 3D models had already been done and now we are analyzing
the main differences between 3D and 2D models. Validation of the results is provided by “in
vitro” mechanical tests using extracted teeth.
Keywords: 2D/3D Tooth Design, Abfraction, Dentistry, Enamel anisotropy, Metal-ceramic
restorations.

2006 ABAQUS Users’ Conference 329

1. Introduction

Finite Element Methods (FEM) analyses have been widely used in engineering since the 60s. They
are an important tool in the understanding of the mechanical behavior of materials used in
Industry. However, in Dentistry this kind of analysis is rather recent. Although the first article
published by FARAH et al. on the subject dates back to 1973, this technique is still little used. That
is mainly due to (i) the difficulty associated with the models elaboration, for they present different
shapes depending on the tooth to be analyzed, and (ii) to the difficulty involved in obtaining the
mechanical properties of the tooth’s constituent materials: enamel, dentin, cementum, pulp,
spongy bone, compact bone and periodontal ligament. Furthermore, little is known about the
contact areas between such materials and their degree of influence on the mechanical behavior of
the tooth as a whole.
FEM enables analyses of both sound and restored teeth. The restorations may be direct, when
inserted directly by the dentist, or indirect, when the restoration itself is made at a laboratory and
later cemented to the patient’s tooth. For each kind of restoration, different types of materials are
employed. The most commonly used materials for direct restorations are composite resin and
amalgam. For indirect restorations, metal alloys, metals and ceramics, all-ceramic and fiber-
reinforcement resins.
Even though there are many variables to be considered, the FEM analyses allow the manipulation
of one parameter only, making it possible to analyze that parameter influence on the mechanical
behavior in general. This is a difficult task to achieve through ‘in vitro’ trials and impossible
through ‘in vivo’ analyses. Those types of analysis are usually carried out by using statistic data,
which demands a great number of samples and long trial periods.
The aim of this paper is to describe the analyses of stress distribution and fracture behavior in
sound and restored teeth using FEM techniques and ABAQUS program.

2. Technique development

The models for the stress and fracture behavior analyses by FEM in two and three dimensions
(2D/3D) were created from images of natural teeth of different types: incisive, canine, premolar
and molar.

2.1. 2D Model

A natural tooth selected was inserted into an epoxy resin (#331, Epoxtec, RJ, Brazil) and
longitudinally abraded up to mesial-distal half distance. Sequential measurements were taken so
as to allow for a correct and precise identification of the abrasion plane. This plane was analyzed
on stereoscopic microscope (Nikon, Model 102) and digitally photographed (Nikon Coolpix 950),
always using a scale for the dimensional calibration of the digital images. Those digital images
were exported to a vectorial drawing software (AutoCad 2000, Autodesk Inc., Neufchatel,
Switzerland). The outline of enamel, dentin and pulp was designed over the real model. Dental

330 2006 ABAQUS Users’ Conference

cavities, restorations and lesions were also designed. The surrounding dental tissues were designed
according to their normal anatomy described in literature. For the periodontal ligament, it was
assumed a thickness of 0.3 mm (Rees, 2003) and a distance of 1.0 mm from the ridge alveolar
bone to the cementum-enamel junction (Lindhe, 1999) (Figure 1).

Figure 1. Outlines of dental structures designed over the natural tooth.

Each part was exported to the FEM analysis program (ABAQUS CAE version 6.5, Hibbit Inc.,
Rhode Island, USA). All structures were considered homogeneous solids and their mechanical
properties (modulus of elasticity and Poisson’s ratios) are described in Table 1.

Tabel 1. Mechanical properties used for the structures of 2D and 3D models.

Material Elastic Modulus (E) (MPa) Poisson´s ratio (ν)
Isotropic Enamel (Rees, 2003) 80000 0.3
Anisotropic Enamel (Rees, 2003) E12 = 80000 E13 = E23 = 20000 ν12 = 0.3 ν13 = ν23 = 0.08
Dentin (Toparli, 2002) 18600 0.31
Cementum (Toparli, 2002) 18600 0.31
Dental Pulp (Rees, 2003) 2.07 0.45
Periodontal Ligament (Rees, 2003) 50 0.49
Spongy Bone (Rees, 2003) 345 0.3
Compact Bone (Toparli, 2002) 13800 0.26
Composite Resin (Ensaff, 2001) 10000 0.3
Ceramic (Ibrahim, 2004) 68900 0.28
Ni-Cr Alloy (Toparli, 2002) 205000 0.33
FZn Luting Agent (Lanza, 2005) 22000 0.35

In most of the analyses the mechanical properties were considered isotropic. Yet the enamel was
constituted of hydroxyapatite crystals organized as prisms which characterized it as anisotropic
material (Habelitz, 2001). For the anisotropic analyses, partitions were created in enamel in
accordance with the orientation changes of prisms. Coordinate axes were defined in order to
determine the main direction of each partition (Figure 2, axis x).
Depending on the type of analysis, the encastre was positioned in different locations. When
compact bones were present, the encastre was made on their base line. Otherwise the encastre was
made on the base line of the outlined model. The models were fixed to prevent rotation and
translation during load application.

2006 ABAQUS Users’ Conference 331

 Figure 2. Dental enamel partitions. Paths created to graphs plot.

The mesh applied to the models was of 4-node quadrilateral elements which led to liable results.
The mesh size was defined differently for each constituent of the model according to the specific
necessities to obtain less distortion. The assessment of the mesh was done using a specific tool
from ABAQUS program (Figure 3). The mesh refinement was realized in specific areas of the
analyses, considered ideal when the stress values found did not present significant differences.

Figure 3. Mesh applied to a metal-ceramic full crown in 2D model of

a premolar tooth.

Load conditions to which the models were submitted must follow the specific interests of the
analyses in accordance with the real situations happening in oral cavities. The functioning of the
teeth in oral cavities depends on some factors:
a) Tooth position on the dental arch: loads in the anterior region are lower than in the
posterior regions because the resultant of the occlusal loads is located in the area next to
temporomandibular join. In a functional occlusion loads in the posterior region are in
vertical direction. For that reason, during the occlusion only the posterior teeth touch, and
during the mandibular movements only the anterior teeth touch. When there is
nonfunctional occlusion some posterior teeth may touch during the mandibular
movements producing loads in horizontal directions. This fact represents a risk of lesions
in the teeth and surrounding tissues (Okeson, 2003).

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 b) Food type: food of rigid consistency transmits more stress to opposing teeth considering
the same masticatory load. DEJAK et al. (2003) using FEM in molars teeth found that the
maximum stresses occur on the occlusal enamel during the mastication of food with
higher modulus of elasticity. The authors found that the least favorable condition was
with non homogeneous food (material of low modulus mixed with small fragments of
bone).
c) Parafunction: parafunction is characterized by the use of oral cavity structures out of their
normal function. Bruxism and tooth clenching cause damages to teeth and surrounding
tissues with high indexes of orofacial pain. In those parafunctions the loads applied on
the teeth increase significantly and the protection system of oral cavity is not active
(Okeson, 2003).
The loading values used for the analyses range from 100N to 800N (Ferrario, 2004). The first
value is in accordance with the average values found in literature for occlusal forces during
physiological function. The last value is related to the average values measured during the
parafunctional activity (non-physiological function). It is important to highlight that those values
correspond to local compressive loads (contact). The second parameter to be considered is the
angle of the applied load related to the contact area plane. The individual contact in each cusp
region leads to the decomposing of that load in horizontal and vertical force vectors. The
measurement of cusp inclination in the teeth models was realized in the Image-Pro Plus 4.5
(Media Cybernetics, USA) program. In physiological situations the local load application must be
simultaneous on the two cusps (Figure 4). In nonphysiological situations load must be applied on
only one cusp. Another factor to be considered is related to the loading type: punctual or in area
(Figure 4). An expressive number of researches present results associated with punctual loads.
However, in the functional process in oral cavity the occlusal contact occurs in an area of
approximately 0.5 mm radius (Okeson, 2003).

Figure 4. Punctual physiological (A) and nonphysiological (B) loading;

physiological (C) and nonphysiological (D) loading applied in a contact area.

3. 3D Models

External diameter measures of the natural tooth were done following the methodology used in 2D
models. The internal diameter measures were done using tooth radiographs. After that, tooth was
inserted into an epoxi resin, and longitudinally abraded up to buccal-lingual half distance. Each
plane was analyzed on stereoscopic microscope and digitally photographed. Two photos were

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obtained for each plane; the first one was captured by using a reference scale for the image
dimensioning and the second one without scale for the outline visualization.
The drawing of each part of the natural tooth was designed in NURBS modeling program
Rhinocerus® (Version 3.0 SR3c, Robert McNeel & Associates, Washington, USA) (Figure 5).
Some outline modifications were done in the model depending on the type of analysis: teeth with
defects or teeth with restorations. Each part was then exported to ABAQUS program. Parts of 3D
models were assumed homogenous and isotropic (Aykul, 2002). In load step it was done a
partition on occlusal face creating a sketch, with 0,5mm radius, and the tension applied related to
load intensity was calculated. The mesh used in that first analysis was a 4-node linear tetrahedral
type.

Figure 5. 3D Model constructed in Rhinocerus®.

(A) Tooth with surrounding tissues; (B) Tooth in detail.

4. Case studies

In the next sections some FEM applications in Dentistry realized by the Biomaterials group of
TerMic Laboratory will be described.

5. Sound teeth

Dental enamel presents a similar behavior to ceramics, being a fragile material and crystalline
(hydroxyapatite crystals). Because of the anisotropic characteristic of enamel some researches try
to present differences of enamel mechanical behavior when submitted to occlusal loads depending
on the load directions in relation to the enamel (Spears, 1993, Las Casas, 2003). Another analyzed
aspect is the local alteration of enamel elastic properties in the presence of dental decay associated
with crystalline changes.
The objective of this research was to analyze the influence of enamel anisotropy on stress
distribution in a sound tooth (Neves, 2003). In order to describe the results, paths were created and
are shown on Figure 2. Results showed that there is a difference in stress distribution between the
isotropic and anisotropic enamel models (Figure 6). However, results also showed that it is

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important to measure the elastic modulus of enamel in decay presence. As this work is still in
progress, nanoindentation and/or atomic force microscopy techniques are being developed
(Habelitz, 2002).

Figure 6: Graphs of results obtained in different paths (A and B).

6. Teeth with abfraction lesions

Abfraction lesions have been attributed to stress concentration on teeth’s cervical region that tends
to flexure under occlusal loads (Lee, 1984, 2002). Those lesions present “V” or wedge shape.
Generally, they are present at three types of dental tissues (enamel, dentin and cement) and must
be restored in order to eliminate the local sensibility and recover the aesthetic. An already formed
lesion represents a defect in tooth structures that can generate concentration and amplification of
local stress, which can reduce the ability on loading support without any damage (Dawid, 1991).
This study assessed the stress distribution on cervical region in premolar teeth with abfraction
lesions. Two-dimensional models were created with different parameters: loading type in sound
tooth, different outlines of abfraction lesions and lesions restored with composite material (Cunha,
2005). Loading modes used can be seen in Figure 7.

Figure 7. Applied loads locations.

The results showed that load 5 had the most damaging effect to the sound tooth. Because of that
load 5 was used in lesion and restored models. The results are presented on figures 8 and 9.

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 Figure 8. Isotropic sound tooth – Maximum principal stresses (MPa).
(A) Physiological load; (B) Load 5.

Figure 9: Maximum principal stresses (MPa), load 5.

(A) Lesion 1; (B) Lesion 1 restored.

According to the results the author (Cunha, 2005) came to the following conclusions:

• Lateral load was capable of generating stress concentration in cervical region of the
sound tooth; conversely, physiological load was not.

• In the cervical region maximum stresses were tensile on the opposite side from the
applied load direction.

• In the cervical lesion models the maximum stresses were concentrated at the tip of the
lesions and presented higher intensity values.

• Lesion 4, which presents the highest length and the least radius of curvature, resulted in
higher stress values compared with the other tested lesions.

• Lesion restoration promoted a significant reduction on tension stresses in cervical region,

when a perfect sealing was considered in tooth-restoration interface.

• Occlusal contact adjustment and an appropriate lesion restoration seem to be efficient

procedures to reduce stress in cervical region.

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As long as the local tensions associated with lesion geometry and loads are known, it is possible to
change those conditions. This can be done with a cavity preparation or with loading direction
modification (occlusal adjustment), increasing restoration longevity and preventing lesion
propagation.

7. Teeth with direct restorations

The “in vitro” analysis was done in teeth with Class I cavity preparation by using different axial
wall inclinations (convergent or parallel), and by inserting composite resin. Those teeth were
sliced in the middle and the defects on the tooth-restoration interface were measured. Based on the
data, a 2D model was designed for each cavity with and without defects. The objective of this
study was to evaluate the influence of axial wall inclinations in relation to defect presence and
stress distribution when submitted to occlusal loading (Silva, 2004). The results showed different
stress distributions in the two analyzed models (Figure 10).

Figure 10. Maximum principal stresses (MPa), physiological load.

(A) convergent cavity with defect and (B) parallel cavity with defect.

Simultaneously mechanical “in vitro” tests were realized to KIC determination on the tooth-
restoration interface. Even with the experimental determination of KIC value, its direct use for
fracture analysis in solids with complex geometry is not easy. The difficulty is due to the necessity
of the determination of the dimensionless constant (Y) associated with a solid/crack/loading mode
system. Another possible approach is to determine the local K (on the crack surroundings) to that
system and compare it with the KIC value, by applying the LEFM fracture criterion (Ewalds, 1986,
Barson, 1999). FEM analyses, which lead to the determination of the J Integral parameter (and
associate K) for these tooth models, are in study.

8. Teeth with indirect restorations

8.1. Porcelain laminate veneers

Porcelain laminate veneers are all-ceramic restorations done with little dental tissue reduction,
limited to enamel tissue. The location of the restoration edge is discussed in literature, that is, on
incisal edge or with lingual extension. The lingual extension is proposed to increase the restoration

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strength. This work evaluated the load effects and fracture behavior by using FEM and mechanical
tests in restored teeth with and without lingual extension comparing with sound teeth (Borges,
2005). By using a sound bovine incisive tooth image, the dental structures were outlined and
alterations were done representing restoration and a luting agent. 200N loads were applied on
lingual surface at a 45-degree angle with the long axis of the tooth. Results showed that there were
no differences on stress distribution and intensity in the different models (Figure 11). When the
load was applied at a 45-degree angle, the highest stresses were located in the region submitted to
the load and in the cervical region of lingual face. The same results about the fracture mode were
found in specimens submitted to mechanical tests.

Figure 11: Maximum principal stresses (MPa), physiological load.

(A) Sound tooth; (B) Cavity preparation on incisal edge;
(C) Cavity preparation with lingual extension.

8.2. Metal-ceramic crowns and fixed partial metal-ceramic prosthesis

Metal-ceramic restorations are widely used in dental prosthesis area for functional and aesthetic
teeth recovery, which suffer damages from decay or fractures (Özcan, 2003). Those restorations
are composed by a metal alloy infrastructure, also called core or substructure, veneering by
porcelain.
The major advantage of ceramic as a biomaterial, according to Rizkalla (2004), is that it can be
produced with different degrees of translucency and almost completely inert. However, its major
deficiency is its incapacity to resist functional stresses imposed in oral cavity, limiting its use as a
restorative material in posterior region. Ceramic materials have rather low fracture toughness
compared with metal alloys, which present 20 to 100 times higher values. The higher values are
due to the capacity of absorbing deformation energy through plastic flow, making metal alloys
capable of withstanding more severe impacts and thermal stresses. Thus, in some occasions,
ceramic fracture happens under clinical conditions.
Ceramic fracture may result in high cost, aesthetic and functional problems to patients. The
reasons for those failures are repetitive stress associated to mastication and trauma. Clinical
studies showed that the ceramic fracture prevalence ranges from 5% to 10% in ten years use
(Coornaert, 1984). Strub (1988) reported a metal ceramic restorations failure rate ranging from

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only 1% to 3% in five years. The success rate found by Glantz (1993) based on the time of use
(from 1979 to 1994) indicated that most of the adhesion losses occur in 15 years and almost all
restorations dislodged in 5 years. Hankinson (1994) and Kelsey (1995) found failure rate ranging
from 2% to 4% after 2 years use, ranging from 20% to 25% after 4 to 5 years due to repeated
occlusal contacts.
FEM was applied in full metal-ceramic crowns (FC) and in 3 element metal-ceramic fixed partial
prosthesis (FPP) (Motta, 2005). In the full crowns two types of cavity preparations (ideal and
incorrect) were realized in order to verify their influence on stress distribution (Proos, 2002).
Besides, punctual and in-area loads were applied.
The FPP models were analyzed according to the loading mode, that is, loads were distributed on
all FPP teeth and only on pontic, as found in other researches (Ibrahim, 2004, Özcan, 2003,
Coornaert, 1984).
When the punctual load was applied simultaneously on buccal and lingual cusps, the results
obtained for FC models showed that maximum stresses presented basically the same distribution
for ideal and incorrect cavities. Those stresses were mainly concentrated at the load application
point, in some areas of metal alloy and on outer buccal ceramic surface. The model presented
maximum stress area in mesial-distal groove region (Figure 12).
The results found for incorrect cavities presented lower stress values suggesting a more
appropriate behavior. One possible explanation is that stresses are associated with solid
deformations due to external loads. As ceramic presents a higher elastic modulus compared with
other materials that compose teeth, a higher volume of that material in the solid corresponds to a
higher stiffness of the system. That happens when a perfect material is considered, with no defects.
However, the higher the porcelain volume the higher the probability of inner defects and cracks
due to the process of porcelain condensation on the infrastructure and sintering. The presence of
defects and cracks leads to a higher probability of solid fracture.
When the compressive load application modes are compared (distributed in a contact area or
punctual), stress distribution on plane does not present significant differences (Figure 13).
However, punctual load values were higher than when the load was distributed on a contact area.
Punctual loads are not obtained in practice, on the contrary, it is common to find small areas of
contact with approximately 0.5 mm radius (Okeson, 2003).
FPP results showed that in order to do a correct analysis of this restoration behavior it is necessary
to distribute carefully the loads on all elements, which constitute the restoration (Figure 14). This
procedure is important to simulate the real functional conditions as close as possible.

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 Figure 12. Maximum principal stresses (MPa), 100N punctual physiological load.
(A) Ideal and (B) incorrect cavity.

Figure 13. Maximum principal stresses (MPa), 100N physiological load

applied on a contact area. (A) Ideal and (B) incorrect cavity.

Figure 14. Maximum principal stresses (MPa), 100N physiological load

applied on all elements (A) and only on the pontic (B).

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9. 3D Analyses

3D models of natural and abfraction lesion teeth have already been constructed and submitted to
FEM analyses (ABAQUS) under physiological and on-lingual-cusp-only loading conditions. The
choice for lingual cusp loading was made based on 2D model results. The results obtained for 3D
models can be visualized in Figure 15.

Figure 15. Maximum principal stresses (MPa). (A) Sound tooth and physiological
load; (B) Tooth with abfraction lesion submitted to lateral load on lingual cusp.

10. Summary

The results found in this study, obtained from 2D/3D FEM analyses of sound and restored teeth,
indicate that this methodology is adequate and convenient for stress distribution assessment. That
methodology enables an efficient approach to mechanical and fracture behavior of systems with
complex geometry and with materials with different mechanical properties submitted to different
loading modes. Therefore, FEM analysis is a powerful tool to characterize dental systems in their
different functional conditions, being of great importance to both dentists and engineers, who are
involved with the development of new materials.
“In vitro” tests of sound and restored teeth are being submitted to a static and cyclic loading under
functional conditions by Biomaterials group/TERMIC to validate the numerical results obtained
from FEM.

11. Acknowledgements

The authors acknowledge Eng. Gabriel A. Tarnowski (LAMEF/UFRGS) and Prof. Fernando
Pereira Duda (PEM/COPPE/UFRJ) for teaching the correct use of ABAQUS program and helping
with the FEM result analyses.

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