Medical Engineering & Physics 34 (2012) 1526–1531

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Medical Engineering & Physics

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Communication

Angled abutments result in increased or decreased stress on surrounding bone of

single-unit dental implants: A finite element analysis
Kebin Tian a , Jiang Chen b,∗ , Lilin Han c , Jin Yang b , Wenxiu Huang b , Dong Wu b
a
School of Stomatology, Fujian Medical University, Fuzhou, Fujian 350000, China
b
Department of Oral Implantology, Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian 350002, China
c
Lishui People’s Hospital, Lishui, Zhejiang 323000, China

a r t i c l e i n f o a b s t r a c t

Article history: The influence of angled abutments on stress is a matter of debate. It is widely accepted that increased
Received 27 April 2012 stress on implants and bone has been associated with the use of angled abutments.
Received in revised form However, comparisons of clinical success rates of implants restored with angled and straight abut-
26 September 2012
ments indicate no significant differences. The aim of the present study was to determine whether angled
Accepted 4 October 2012
abutments could result in decreased stress on surrounding bone of single-unit dental implants. By means
of finite element analysis (FEA), four simplified models were designed to simulate clinical scenarios in
Keywords:
which that implants were placed in an ideal axial position or at an angled position. Each implant was
Finite element analysis
Angled abutment
paired with a straight or angled abutment. A simulated occlusal load of 100 N was applied along the ver-
Dental implant tical axis of the jawbone. The von Mises stress and strain were recorded for each model. The numerical
Biomechanics results showed that angled abutments resulted in decreased stresses when implants were not placed in
ideal axial position. The present study identified by means of FEA that angled abutments could result in
decreased stress on the supporting bone of implant system and may provide some clues to resolve the
debate regarding the influence of angled abutments.
© 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

1. Introduction strain produced by an abutment system at three abutment angula-

The placement of endosseous dental implants has become an
increasingly common practice. Ideally implants should be placed
parallel to each other, paralled to adjacent teeth and be vertically
aligned with axial forces [1,2]. However, in many clinical instances,
achieving this may be impossible due to deficiencies in alveolar
bone [2,3]. Frequently implants must be placed in angled pos-
itions, complicating restoration using straight abutments. Angled
abutments have been introduced to correct such cases [2–4,1,5].
The implant system is composed of 2 components: the implant
body and the restorative abutment. The implant body is placed
at an angle and the corresponding abutments must be angled to
align the components so that a single implant crown or bridge can
be constructed. As a result of the use of the angled abutments,
occlusal forces on the restorative crown or bridge can create dif-
ferent stress in the bone compared to straight abutments. The
influence of angled abutments on stresses is a matter of debate
[6–8]. It has been widely accepted that increased stress on implants
and bone has been associated with the use of angled abutments
[9–11]. Clelland et al. [9] analyzed by means of FEA the stress and
tions. They concluded that there was an increase in the magnitude
of the stress and strain as abutment angulation increased. However,
some investigations have demonstrated that angled abutments did
not detrimentally affect clinical success rates [2–4,1]. Sethi et al.
[1] conducted a five-year prospective study. A total of 2261 2-stage
implants were placed in 467 patients with angled abutments ran-
ging from 0◦ to 45◦ . They reported that angled abutments may be
used without compromising the long-term implant survival. Fur-
ther studies are needed to correlate the biomechanical research
data with clinical results.
Finite element analysis (FEA) is a useful tool to provide detailed
qualitative and quantitative data. It has been widely used to predict
the biomechanical behavior of various dental implant designs and
the effect of clinical factors on implant success [7–13]. When abso-
lute values are not of interest, simplified models can be effectively
used in qualitative FEA of dental implants [14,15]. This finite ele-
ment study used simplified models that did not attempt to reflect
every clinical situation. It provided only general insight into the
biomechanics of angled abutments under average conditions.
The aims of this paper are as follows:

• To determine whether angled abutments could result in

∗ Corresponding author. Tel.: +86 591 83700838. decreased stress and promote better stress distribution on sur-
E-mail addresses: Dentistjiangchen@sina.com, dentistjiang@sina.com (J. Chen). rounding bone of single-unit dental implants.

1350-4533/$ – see front matter © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.medengphy.2012.10.003
 K. Tian et al. / Medical Engineering & Physics 34 (2012) 1526–1531
Table 1
Analysis conditions and dental of four dental implant models.
Model details
Model 1 A straight implant connected to a straight abutment
Model 2 A straight implant connected to an angled abutment
Model 3 An angled implant connected to a straight abutment
Model 4 An angled implant connected to an angled abutment
2. Methods
For the present study, four three-dimensional finite element
models were created and analyzed using ANSYS 9.0 software
(ANSYS, Canonsburg, PA). Each model was composed of a simplified
jawbone, an implant and an abutment (Fig. 1). The simplified jaw-
bone was [13–15] approximately 9 mm in width bucco-lingually
and 20 mm in height corono-apically and 20 mm in length mesio-
distally. The simplified jawbone consisted of two layers: a cortical
layer and a cancellous layer. The cortical bone was modeled as
a 1.5 mm layer on the facial, lingual, and occlusal aspects of the
bone wedge. The implant, 10 mm long a diameter of 4.1 mm was
embedded in the jawbone model at a 90◦ or a 70◦ angle to the hori-
zontal plane of the jawbone to simulate common clinical scenarios
in which implants were placed in the ideal axial position or at an
angle. The implant was then fitted with a straight abutment or a
20◦ angled abutment [9,13] with a modification in the orientation
of the implant. Details of the studied models are summarized in
Table 1. All of the materials in the current study were assumed to be
homogenous, linearly elastic and isotropic to simplify computation
processes.
The mechanical properties (Table 2), boundary conditions and
the nature of loading were obtained from relevant studies [5,13].
The interface between the cortical and cancellous bone layers and
between the implant and each of the bone layers was assumed to
be properly bonded to corresponds with good osseointegration.
The lower surface of the model and the medial and distal planes
of bone were completely constrained [16]. The numerical models
were meshed with 1.0 mm of element sizing (Fig. 1H). For angled
abutments, dental implants, cortical bone and trabecular bone, a
10-node solid element of SOLID 187 was used. Meshed models con-
tained 116,428 nodes and 75,182 elements with a small difference
in various models (Table 1). Forces of 100 N were applied along the
vertical axis of the jawbone.
Occlusal forces are typically 100 N under normal biting, with
higher forces occurring in patients suffering from bruxism or para-
function [12]. This single loading condition was selected because
the angle of force application affected the stress and strain magni-
tude and distribution pattern in the bone [9,16] and the intention
of this paper was to provide only a relative qualitative evaluation.
The von Mises values were used to display the stress and strain in
the bone and implant-abutment unit in all four models, maximum
von Mises stress and strain were recorded for each model.
3. Results
The analysis of the von Mises stress values revealed that maxi-
mum stress concentrations were located at loading areas of implant
abutments for all models (Fig. 2). Additionally, high stress values
were located at cervical cortical bone regions adjacent to implants,
Table 2
Mechanical properties of materials.
Young’s modulus (MPa) Poisson’s ratio
Cortical bone [5] 13,700 0.30
Cancellous bone [5] 1370 0.30
Titanium alloy [12] 110,000 0.30
1527
Elements Nodes
75,182 116,428
74,807 115,923
75,224 116,482
75,392 116,728
relatively low stress values were identified cancellous bone regions
in all models due to the lower elastic property of this type of
bone compared to cortical bone. The maximum values of stress
and strain in each model are shown in Table 3. Among the four
models evaluated in this study, the maximum stress value (55 MPa)
was observed in Model 2 and the maximum strain value (1504 ␮␧)
was observed in Model 3. The values of maximum von Mises stress
and strain in Model 1 were smaller than those in Model 2, sug-
gesting that when single-unit implants were placed in the ideal
axial position, angled abutments resulted in increased stress on
surrounding bone. The values of the maximum von Mises stress
and strain in Model 3 were greater than those in Model 4, indi-
cating that when single-unit implants were not placed in the ideal
axial position, angled abutments could result in decreased stresses
on surrounding bone.
Moreover, the application of angled abutments had a significant
effect on the stress and strain distribution pattern of the implant
system. The stress and strain fields (Fig. 3) were distributed sym-
metrically in Model 1, whereas the stress and strain distributions
were asymmetric in Models 2, 3 and 4. The stress and strain distri-
butions were more asymmetric in Model 3 than in Model 4. This
may be due to the angled abutment correcting the direction of
implant in Model 4, resulting in better stress and strain distribution.
4. Discussion
There was a controversy between clinical results and biome-
chanical analysis in previous studies regarding the influence of
angled abutments [6–8]. A limited number of studies [2–4,1]
demonstrated that angled abutments did not detrimentally affect
the survival of dental implants. However, increased stress on
implants and bone associated with the use of angled abutments had
been widely confirmed [7,9,10]. The stress and strain distributions
around osseointegrated dental implants were affected by a num-
ber of biomechanical factors, including the type of loading, material
properties of the implant and the prosthesis, implant geometry,
quality and quantity of the surrounding bone, and the nature of
the bone-implant interface. Many assumptions concerning biome-
chanical factors were somewhat different in previous studies
[7,9,10]. For this study, a number of variables that may influence
study results were controlled, such as bone construction and com-
position (simplified jawbone with 1.5-mm-thick cortical layer),
implant position (at a 90◦ or 70◦ angle to the horizontal plane of
jawbone), abutment angle (20◦ ), and type of loading (100 N applied
along the vertical axis of jawbone). Under such circumstances, data
obtained from this study may represent an approximate simula-
tion of clinical situations during which implants were placed in
an ideal axial position or at an angle. However, there were inher-
ent limitations in this FEA that limit the ability to make definitive
assumptions regarding clinical performance. The structures in the
Table 3
Maximum values of von Mises stress and strain of models.
Model 1 Model 2 Model 3 Model 4
Stress (MPa) 13 55 33 17
Strain (␮␧) 1112 1140 1504 1210
1528 K. Tian et al. / Medical Engineering & Physics 34 (2012) 1526–1531

Fig. 1. Three-dimensional finite element models of an implant-abutment system used in the study. Dimensions of the implant connected to a straight abutment (A), the
implant connected to a 20◦ abutment (B), and a cross-section of jawbone (C) in millimeters. All models were combined by Boolean operations. Model 1 (D): the implant
embedded in the bone model at a 90◦ angle to the horizontal plane, connected to a straight abutment. Model 2 (E): the implant embedded in the bone model at a 90◦ angle to
the horizontal plane, connected to an angled abutment. Model 3 (F): the implant embedded in the bone model at a 70◦ angle to the horizontal plane, connected to a straight
abutment. Model 4 (G): the implant embedded in the bone model at a 70◦ angle to the horizontal plane, connected to an angled abutment. (H) Meshed implants and bone.

model were all assumed to be homogenous and isotropic. All inter-
faces between the materials were assumed to be osseointegrated.
Stress was generated through vertical force only. In reality, occlusal
force has a transverse component in addition to a vertical compo-
nent.
Quantitative stress analysis was less reliable in simplified
models because it did not represent the complex anatomical config-
uration of dental structures. But simplified models were acceptable
when investigating the biomechanical behavior of dental structures
qualitatively. Therefore, the results provide only general insight
into the biomechanics of angled abutments under average condi-
tions.
FEA was used to assess stress on angled abutments in previous
studies [5–7,10]. Kao et al. [10] noted that abutment angulation up
to 25◦ can increase the stress in the peri-implant bone by 18% and
the micromotion level by 30%. Lin et al. [8] also found that implant
and cortical bone strain were higher for an angled abutment of 20◦
than that for straight abutments. Saab et al. [6] stated that using an
angled abutment may decrease the strain on bone when restoring
implants in anterior maxilla. In the present study, it was recognized
by means of FEA that angled abutments could result in decreased
stresses on the surrounding bone of dental implants when implants
are not placed in an ideal axial position. The reduction of stress
and strain in the implant system may be the result of combination
 K. Tian et al. / Medical Engineering & Physics 34 (2012) 1526–1531 1529

Fig. 2. Distribution of von Mises stress (MPa) in model (right), in implant (center), and the cross sectional view of the model (left). (A) Model 1, (B) Model 2, (C) Model 3, (D)
Model 4. Blue to red color represents stress values from lower to higher, respectively. (For interpretation of the references to color in this figure legend, the reader is referred
to the web version of the article.)

of angled abutments with a modification in the orientation of the
implant. When the implant was not placed in the ideal axial posi-
tion in Models 3 and 4, it resulted in an unfavorable distribution
of stress. An angled abutment was used to correct the direction of
implant in Model 4; however, a straight abutment could not correct
the direction of the implant in Model 3. That difference resulted in
better stress distribution in Model 4 than in Model 3. These results
were in agreement with previous clinical [3] and experimental [17]
findings that have indicated that angled abutments may be a suit-
able restorative option when implants have not been placed in the
ideal axial position. The findings of this analysis may be translated
and used by the clinician in the decision-making process regarding
the positioning of implants and the selection of angled abutments.
Further research should be conducted to analyze principal stress
1530 K. Tian et al. / Medical Engineering & Physics 34 (2012) 1526–1531
Fig. 3. Distribution of von Mises strain (ε) in four models: cross sectional view. The
stress and strain fields were distributed symmetrically in Model 1 (A) and asym-
metrically in Model 2 (B). The stress and strain distributions were more asymmetric
in Model 3 (C) than in Model 4 (D).
and strain and provide some conclusions regarding bone remodel-
ing or damage as well as the influence of the bone–implant interface
under various conditions.
5. Conclusions
Within the limitations of this FEA study, the following conclu-
sions of clinical significance were drawn:
1. Under certain conditions, angled abutments could result in
decreased stress and promote better stress distribution on sur-
rounding bone of single-unit dental implants.
2. Angled abutments may result in decreased stress on surround-
ing bone of single-unit dental implants when implants are not
placed in the ideal axial position. From a biomechanical point of
view, consistent with previous clinical and experimental find-
ings, angled abutments may be a suitable restorative option
when implants are not placed in the ideal axial position.
Funding
This study was supported by the fund of Ministry of Health of
the People’s Republic of China (Grant No. WKJ2008-2-064).
Ethical approval
Not required.
Acknowledgement
The authors wish to acknowledge the assistance and technical
support for creating and analyzing the model provided by Dr. Han
Tian, Department of Biological Science and Technology, University
of Fuzhou.
Conflict of interest
None declared.
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