Received: 24 June 2019 Revised: 1 October 2019 Accepted: 7 October 2019

DOI: 10.1111/cid.12858

ORIGINAL ARTICLE

Effect of different biocompatible implant materials on the

mechanical stability of dental implants under excessive
oblique load

Khaled Bataineh PhD | Mohammad Al Janaideh MSc

Department of Mechanical Engineering,
Jordan University of Science and Technology,
Irbid, Jordan
Correspondence
Khaled Bataineh, Department of Mechanical
Engineering, Jordan University of Science and
Technology, P.O. Box 3030, Irbid 2210,
Jordan.
Email: k.bataineh@just.edu.jo
Abstract
Background: Metallic implants such as titanium are much harder than the neighbor-
ing bone. This high difference may generate larger stress at the bone-implant inter-
face during load transfer which leads to implant failure. The use of biocompatible
polymer such as CRF-polyether ether ketone (PEEK) with strength comparable with
the bone might lead to lower and better stress distribution to the supporting peri-
implant bone.
Purpose: The aim of this study is to investigate the effect of using carbon reinforced
PEEK composite material for fixture/abutment on stress distribution in peri-
implant bone.
Materials and Methods: Three-dimensional (3D) model of dental implant placed in
the first mandibular molar is constructed from computed tomography scan. Five dis-
tinct models using a combination of titanium, CRF-PEEK, lithium disilicate for
implant/abutment materials are studied. 3D finite element analysis (FEA) is used to
evaluate the stress distribution at implant-bone interface under excessive oblique
load. The physical interaction between several contacting bodies is numerically inves-
tigated. The effect of friction coefficients between the indenter and occlusal surface
and between the implant and peri-implant bone is determined.
Results: FEA results show that there is no significant difference in the distribution
pattern of stress at implant-bone interface among the different material models stud-
ied. The highest maximum and lowest minimum principal stresses were always
located in the cortical bone and never in the cancellous bone which is consistent with
the existing literature. Off-axis loading can result in unfavorable forces on the
implant, jeopardizing the long-term success because of excessive lateral loads. Cur-
rent FEA results agree with previously published work.
Conclusion: Substitution of titanium implant by PEEK implant does not provide any
advantages in regards to better stress distribution to the peri-implant bone. The
strain thresholds of Frost's mechanostat theory that are suitable for long bone could
not be applied for alveolar bone.

KEYWORDS
biocompatible, biomaterials, CFR-PEEK, deformation, dental implant, fatigue, finite element
simulation, stress distribution

Clin Implant Dent Relat Res. 2019;1–12. wileyonlinelibrary.com/journal/cid © 2019 Wiley Periodicals, Inc. 1
2 BATAINEH AND AL JANAIDEH
1 | I N T RO D UC T I O N
Dentistry has witnessed significant advancements in dental techniques that
provide an effective solution for tooth loss. A single tooth can be success-
fully replaced with implant retained crown that provides the same function
and esthetics. Due to the promising value of dental implants, they received
significant attention from many researchers and providers recently. Due to
the complex behavior of the dental implant, the evaluation of long-terms
success is not fully determined yet. The success and survival of dental
implant depend mainly on the quality of the bone, nature of bone-implant
interface, and stress distribution at bone-implant interface.
Dental osseointegration, defined as the rigid fixation of the implant
to the bone with the ability to withstand occlusal forces, plays a crucial
role in implant stability. One of the main factors affecting the
osseointegration process is the stress at the bone-implant interface. The
main factors affecting the stress distribution at the bone-implant inter-
face are type and magnitude of loading, material properties of the
implant, implant geometry, surface structure, and implant design quality
(diameter and length).1 Thicker cortical bone and higher density of the
core are the preferred conditions for implant stability. The stress values
at bone-implement interface are inversely proportional to the cortical
bone thickness and proportional to the cortical bone modulus of elastic-
ity.2 Mechanical properties of restorative materials significantly affect
the implant-bone interface zone's stress distribution and load transfer.3
Modulus of elasticity and fatigue strength are the main mechanical
properties that affect the stability of the implant. Crown made of low
modulus of elasticity materials reduce the transmitted occlusal forces
to bone. For example, a crown made of acrylic resin (has low modulus
of elasticity) reduces the transmitted forces to the bone by about 94%
when compared with Zirconia (high modulus of elasticity).4 It has been
reported that low modulus of elasticity crown materials, like acrylic
resin, acts as a shock absorber for occlusal impact forces. Hence, due
to their damping effect, the effect of occlusal forces on the bone-
implant interface reduces significantly.5
FEA is a powerful design tool. It has been successfully used to assess
the design characteristic of highly complex geometries of mechanical
assembly. FEA is a method of breaking down a complex geometry into
manageable “elements” or simpler geometries whose boundary condi-
tions are known. Solid models are used as a basis for FEA analysis. Build-
ing solid models is the first step where they can be further transferred
directly into finite element software for execution of FEA. Due to the
fact that FEA method has the ability to deal with complex geometry,
complex material behavior, and complex loading conditions that usually
encountered in dental implants applications, large number of FEA studies
were conducted to investigate dental implant designs, the performance
of restorative materials, and the stability of the surrounding
bone.5-13,15,17,21-23 FEA offers a powerful tool that allows researchers to
study the mechanical behavior of new implant designs, new modifica-
tions, new materials, and the feasibility and reliability of these new
designs and systems before conducting highly complicated in- vivo
experimentations. Successful utilizing of FEA allows studying different
alternatives efficiently, which leads to improve implant performance, that
has long-term success and survival under clinical conditions.6,8-11 More-
over, FEA offers the possibility to predict the stress distribution inside
mandible bone for various dental implant designs during mastication
which otherwise impossible to perform in vivo measurements.6,7
The diameter of the implant and its length are considered the main
factors affecting the stress distribution in the surrounding bone.13-17
Al-anwar et al conducted FEA study to investigate the effect of implant
diameter and length on stress distribution in surrounding bones.16
Himmlová et al performed FEA to study the effect of implant length and
diameter on stress distribution in adjacent bone.17 Their FEA results
showed that areas of maximum stress are located around the implant
neck. Moreover, stress values decrease with increasing implant diameter
and length. Furthermore, their simulations results predicted that implant
diameter has a more pronounced effect compared to the length. Eazhil
et al confirmed through FEA that that maximum Von Mises stresses
were located around the implant neck and von Mises stress decreases
with increasing implant diameter.18 It was reported that the implant
diameter played more significant roles in reducing cortical bone stress
and enhancing implant stability, while implant length was more effective
in reducing cancellous bone stress.13 For region with good quality bone,
to ensure high success rate, it is recommended that implants should be
more than 14 mm in length and more than 4 mm in diameter.19,20
Moraes et al evaluated the effect of varying the diameter, connection
type, and loading on stress distribution in the cortical bone for implants
with a high crown-implant ratio using FEA tool.21 Their results showed
that using implants with a wide diameter leads to lower values of stresses
in the cortical bone region compared to regular diameter, regardless of
the connection type. Moreover, Morse taper implants showed better
stress distribution compared to other connection types.
The connection type is an important factor in the biomechanics of
implant placement. Research showed that implants with a conical
internal connection (Morse taper) exhibit better stress distribution in
the bone tissue when compared with external hexagon implants.22,23
On the other hand, one study concluded that using Morse taper did
not reduce the stress at bone-implant interface.24
Interest in PEEK (polyether ether ketone) is growing due to their suc-
cessful implementation in the development of hip prostheses and plates
for fracture fixation due to its similar stiffness to bone.25 Due to their
low stiffness compared to the cortical bone, addition of composites, such
as carbon fiber (CFR-PEEK) can increase their stiffness to match that cor-
tical bone.25 Metallic implants are at least six to eight times harder than
the neighboring bone. This high difference may generate larger stress at
the bone-implant interface during load transfer. It is hypothesized that
implant with stiffness comparable with the bone might lead to lower and
better stress distribution to the supporting peri-implant bone.
Certain levels of mechanical load are required for normal bone remo-
deling.26 Biologic implant failures occur when the transferred occlusal
forces exceed the load-bearing capacity of the implant-bone interface.27
This appeared as bone loss around the coronal portion of the implant. If
this excessive load still persists, the bone loss can grow enough to cause
the entire implant to loosen or become useless. The implant does not
have a shock absorbing property provided by the periodontal ligaments
of natural teeth. The periodontal ligament allows a slight physiologic
BATAINEH AND AL JANAIDEH 3

movement of teeth; thus, absorbed the impact of excessive load.28 The
direction of the occlusal forces is an important factor responsible for the
translation of the forces to the implants and to the surrounding bone. It
has been reported that axial loads which directed through the long axis
of the implants are well-tolerated. On the other hand, marginally off-axis
loads generate bending moment at the fixture. This bending moment
generates larger stress values at the implant-bone interface which usually
exceeds the bearing capacity of the peri-implant support bone. This ulti-
mately initiates bone loss at the implant-bone interface. Continuation of
applying this off-axis loads may induce further bone loss and likely will
lead to implant failure.
The aim of this study is to investigate the effect of using PEEK
composite for fixture/implant on stress distribution in peri-implant
supporting bone. Moreover, the effect of physical interaction
between different contacting bodies in load transfer to peri-implant
TABLE 1 Frost's model classifications
Strain range Bone response
ε < 0.00005 - 0.0002 disuse atrophy
0.0002 < ε < 0.0025 steady state (remodeling woven bone to
lamellar bone
0.00025 < ε < 0.0035 Fatigue damage occur, but bone remodeling
repairs the damage
ε > 0.0035 pathological bone
bone is numerically evaluated. Due to the complex behavior of dental
implant, FEA is utilized in this study. A hemispherical indenter is used
to apply occlusal excessive oblique load.
2 | B O N E F A I L U RE T H E O R I E S
Two failure theories are used in this study to predict failure, one is based
on “Frost's mechanostat theory” and the second is based on “The
maximum-normal-stress (MNS) theory”. The section below gives brief
review of those two theories. A mentioned previously, a certain level of
mechanical load to the bone can encourage the MNS theory rage bone
remodeling, exceeding this level, the bones degradation initiates. This
level depends on the bone volume, architecture, and the ability of the
calcified tissue to remodel in response to function.29 Frost proposed a
model to describe the bone response to mechanical loads.26 The pro-
posed model depends on the strain magnitude ε which can be directly
correlated with the amount of induced stress. In oral environment, the
amount of strain induced in bone depends on occlusal loads, their line of
action, and on the mechanical properties of the bone. Frost's theory pro-
posed four microstrain zones, which correlated to a mechanical adapta-
tion: (a) disuse atrophy, (b) steady state, (c) physiological overload, and
(d) pathological loading.30 The Frost's theory can be summarized
according to the below classifications (Table 1).
The Frost's model applies to the long bone under static loads con-
dition. The question is how to relate Frost's theory on long bone

FIGURE 1 3D model of implant placed in the first molar region, right: implant components, middle: perspective view with dimensions, left:
section view
4 BATAINEH AND AL JANAIDEH
under static load to alveolar bone and implants under cyclic impact
mastication loads. Chang et al concluded that the principles of Frost's
mechanostat theory on destructive mechanical forces can be applied
to dental implants placed in the alveolar jaw.30
However, it remains unclear how the strain thresholds identified
on long skeletal bones would correlate to the alveolar bone. For the
sake of simplicity, this study uses the principle of Frost's theory as
general guidelines for predicting peri-implant bone failure.
As mentioned previously, failure of the implant usually due to peri-
implant bone loss due to excessive load. The bone is brittle material clas-
sified according to the amount of strain failure which is less than 0.05.
Brittle material does not exhibit an identifiable yield strength, therefore
they are typically classified by ultimate tensile and compressive
strengths, Sut and Suc, respectively (where Suc is given as a positive quan-
tity). The most widely accepted failure theory for brittle materials (frac-
ture criteria) is the MNS theory.31 The MNS theory predicts failure
whenever one of the three principal stresses equals or exceeds the
strength. The stress state in dental implant is three-dimensional (3D),
therefore, there are three principal stresses can be arranged as σ 1 ≥ σ 2 ≥ σ 3.
This theory predicts that failure occurs whenever σ 1 ≥ Sut or σ 3 ≤ −Suc.31
In this study, the MNS theory is used to predict failure in peri-implant
bone.31 It is worth mentioning that principal stresses are used in biome-
chanical FE studies for bones.32-34 The compression and tensile stress
values in the peri-implant support bone were used to evaluate the effect
of different materials used. The ideal material should provide better load
transfer to the peri-implant bone. On other words, it should redistribute
the load uniformly and preventing stress concentration area. This can be
seen by investigating the maximum tensile and maximum compressive
stress at the implant-bone interface.
3 | MATERIALS AND METHODS
3.1 | 3D model of implant
In order to investigate the effect of using different biocompatible
materials for fixture/abutment on stress distribution in peri-implant
F I G U R E 2 Finite element
model, the mesh was refined at
critical regions, A, sectional
view. B, isometric view
BATAINEH AND AL JANAIDEH 5

support bone, a 3D model of a mandibular segment of bone with sin-
gle threaded tapered screwed dental implant and its superstructures
is built in this study. The first mandibular molar segment is digitized
with computed tomography (CT). Crown is also digitized with a CT
scanner. The stereolithography (STL) files of mandibular and crown
are imported in the commercial solid modeling software (SolidWorks
2018). Several Boolean operations were used to assure the interfacial
mesh congruence. The implant and abutment connections are created
using SolidWorks 2018. The implant system was then imported in a
finite element software package ANSYS 18.1 to execute FEA (Ansys
Inc., Canonsburg, Pennsylvania). Figure 1 shows the 3D model of the
implant placed in the first molar region. The dimension of the mandi-
ble at the considered site is 27 mm high and 15.5 mm wide. The man-
dible consists of a spongy center surrounded on average by 1.5 mm of
cortical bone. A Ø 4.1 mm × 12 mm single threaded tapered implant
with Morse tapered connection is selected in this study. The crown is
made of lithium disilicate (LD). Cement thickness layer of 40 μm thick-
ness is modeled. The implant screw is placed vertically in a modeled
cortical and trabecular bone.

3.2 | Finite element modeling

F I G U R E 3 Boundary conditions and applied loading (arrow) for
the used model
T A B L E 2 Five models studied (crown material = LD, implant
diameter = 4.1 mm, implant length = 12 mm)
Model # Implant material
1 Ti 6AL 4V ELI
2 Ti 6AL 4V ELI
3 CFR-PEEK
4 CFR-PEEK
5 CFR-PEEK
Mesh refinement applied at three critical locations; occlusal surface,
threads of the abutment and implant, and at the implant-bone inter-
face. Mesh independent study is conducted to ensure that FEA results
are independent of the mesh density. The finite element model is
shown in Figure 2. The boundary conditions and the oblique load are
shown in Figure 3.
The ANSYS software offers several options to simulate the inter-
action between contacting bodies; frictional, frictionless, rough,
bonded, no separation, and so on. Boned contact is used for the con-
tact between crown-cement layer, cement layer-abutment, abutment-
fixture, cancellous bone-cortical bone. The contact between the
crown and the opposing tooth is considered frictional which allow for
slides and space formation in order to approach a real situation. More-
over, the effect of contact type between fixture and peri-implant
bone on the stress is studied.
3.3 | Materials
Abutment material
In this work, the effect of implant fixture/abutment made of Ti-6Al-
Ti 6AL 4V ELI
4V or PEEK composite, or LD on stress distribution is studied. Five
CFR-PEEK
distinct models composed of titanium abutment with implant, CFR-
Ti 6AL 4V ELI
PEEK abutment with titanium implant, titanium abutment with CFR-
CFR-PEEK
PEEK implant, and CFR-PEEK abutment with implant are studied
LD
(Table 2). All models were identical, except for the properties of the

TABLE 3 Mechanical properties of materials used in the study

Material Young's modulus (GPa) Poisson's ratio (ν) Yield strength (MPa) Flexural strength MPa)
18
Ti–6Al–4V 110 0.32 800
Zinc phosphate cement18 14 0.35 29
17
LD 96 0.23 356.7
30% CFR-PEEK13,19 18 0.39

Abbreviation: LD, lithium disilicate.

6 BATAINEH AND AL JANAIDEH

used materials. The crown is made of LD. In this study, the mechanical
properties of implant, abutment, and screw were all treated to be iso-
tropic, homogeneous and linear elastic. Bone is an anisotropic material
where their physical properties are direction dependent. Recent stud-
ies have concluded that anisotropy has significant effects on peri-
implant stress and strain, and careful consideration should be given to
its use in biomechanical FE studies. 35
For example, it was reported
that the percentage increase of stress and strain in the anisotropic
properties should be known. Structural material damping constants
should be available. Time history of the dynamic load components
should be known. Searching the literature, to the best of our knowl-
edge, there are no such data published. We restore to the static analy-
sis. This is the reasons why most FEA studies on dental implant
conducted under static conditions. The effect of the dynamic load is
higher than the effect of the static load. Although there is no universal
relation describing how the static load should be magnified to account

case reached up to 70% compared to isotropic model.17 For this rea- for the dynamic effect, we choose to add 30% loading to the implant.

son, the anisotropy of cortical and cancellous bone was used in this The average masticatory force ranges between 75 and 100 N.21 The

study (Tables 3 and 4). The effect of mechanical properties of mate-
rials on stress distribution at the implant-bone interface is evaluated
by building.
force components chosen in this study are; 13.45 N, 100 N, and
36.5 N in a lingual, an axial, and a mesiodistal direction, respectively
(Figure 3). This simulates an average masticatory force in a natural,
oblique direction.

3.4 | Loading conditions 4 | RESULTS

The actual masticatory forces under the oral environment has a
dynamic nature to it. Performing dynamic analyses for dental implant 4.1 | Physical interactions between occlusal surfaces
is highly challenging problem. The time dependent of materials Figure 4 shows the simulation results of principal stresses at the
occlusal surface. FEA results predict that there is no significant differ-
TABLE 4 material properties for bone13 ence with friction coefficient ranging between [0.1-0.4]. The maxi-
mum tensile stress in the crown is always located in the fossa of the
Modulus of Modulus of Poisson's
elasticity (Gpa) rigidity (Gpa) ratio crown. Under the amount of oblique load studied, the maximum ten-

Cortical Ex = 12.7 Gxy = 5 vx = 0.18 sile stress is well below the ultimate strength of the crown material.
Moreover, the indenter has three area of contact of the occlusal sur-
Ey = 17.9 Gyz = 7.4 vy = 0.28
face. The maximum compression stress is always located at the trian-
Ez = 22.8 Gxz = 5.5 vz = 0.31
gular ridge of the crown. The values of the maximum compression
Cancellous Ex = 0.21 Gxy = 0.068 vx = 0.055
stress is well below the compression strength of the crown material.
Ey = 1.148 Gyz = 0.434 vy = 0.322
Furthermore, it is assumed that the crown is bonded to the abutment
Ez = 1.148 Gxz = 0.068 vz = 0.055
perfectly through using adhesive resin cement. The contact between

F I G U R E 4 Effect of the friction coefficient between the indenter and occlusal surface on maximum and minimum principal stresses. A,
bonded. B, μ = 0.1. C, μ = 0.2. D, μ = 0.4
BATAINEH AND AL JANAIDEH 7

the crown and cement layer is simulated through boned contacts
offered by ANSYS. Similarly, the physical interactions between
cement layer and abutment surfaces is modeled through bonded con-
tact offered by ANSYS features.
4.2 | Effect of implant and abutment materials
The effect of mechanical properties of materials on stress distribution
at the implant-bone interface is evaluated by building five distinct
models composed of titanium abutment with implant, CFR-PEEK
abutment with titanium implant, titanium abutment with CFR-PEEK
implant, and CFR-PEEK abutment with implant. Table 5 summarizes
the different stresses for all prosthetic components of the dental
implant. The values of maximum tensile stresses in the cortical bone
for all models is almost equal to 33 MPa, while the maximum com-
pression ranges between 38 and 41 MPa. Figures 5 and 6 present
maximum tensile and compression stress distribution in the cortical
bone. It can be seen that maximum and minimum principal stresses
were always located in the cortical bone and never in the cancellous
bone which are in agreement with the existing literature.39
Figure 7 shows the deformation of the bone due to application
of oblique. The maximum displacements for all models studied are

TABLE 5 Results of the stress peaks in the different structures of the model (MPa)

Model #1 Von Mises implant (MPa) Von Mises abutment (MPa) Tensile cortical/medullar (MPa) Compression cortical/medullar (MPa)
1 178.3 184.5 33.63/2.28 −41.02/−5.62
2 159.73 192.61 33.66/2.28 −41.15/−5.588
3 67.257 261.05 33.5/5.557 −38.04/−6.37
4 99.776 168.09 33.49/5.547 −38.125/−6.63
5 64.46 131.67 33.59/2.31 −41.11/−5.833

F I G U R E 5 Max tensile stress in peri-implant bone comparison with scale in MPa. A, titanium implant and abutment. B, titanium implant and
CFR-PEEK abutment. C, CFR-PEEK implant and titanium abutment. D, CFR-PEEK implant and abutment. E, titanium implant and LD abutment.
LD, lithium disilicate
8 BATAINEH AND AL JANAIDEH

F I G U R E 6 Maximum compression stress in peri-implant bone, A, titanium implant and abutment. B, titanium implant and CFR-PEEK abutment. C,
CFR-PEEK implant and titanium abutment. D, CFR-PEEK implant and abutment. E, titanium implant and LD abutment. LD, lithium disilicate

F I G U R E 7 Total deformation in peri-implant bone, A, titanium implant and abutment. B, titanium implant and CFR-PEEK abutment; C, CFR-
PEEK implant and titanium abutment. D, CFR-PEEK implant and abutment. E, titanium implant and LD abutment. LD, lithium disilicate
BATAINEH AND AL JANAIDEH
F I G U R E 8 Max principal strain in peri-implant bone comparison. A, Titanium implant and abutment. B, titanium implant and CFR-PEEK abutment.
C, CFR-PEEK implant and titanium abutment. D, CFR-PEEK implant and abutment. E, titanium implant and LD abutment. LD, lithium disilicate
around 0.01 mm. The strain distribution for all models are shown in
Figures 8 and 9. The maximum strains for all the models studied
ranges between 0.0136 and 0.0165. For all models studied, the
highest strain always located at the implant-bone interface. The PPE
implant and PEEK abutment has the highest amount of induced
strain.
5 | DISCUSSION
Due to the complex shape of the chosen occlusal surface, the exis-
tence of threads, the complex interaction between the prosthetic
components of the dental implant, a large number of elements is
needed to ensure that the FEA results do not depend on the density
of the mesh. This large element will serve to accurately simulate the
load transfer to the region of interest. A model that consists of
3 875 423 elements was used for the entire simulations.
Under actual chewing process, the occlusal forces are generated due
to colliding between two opposing teeth. Frictional contact is chosen to
accurately simulate this process. The ANSYS software offers several
options to simulate the interaction between contacting bodies; frictional,
frictionless, rough, bonded, no separation, and so on. In frictional contact,
9
sliding motion is permitted, while in bonded contact, the contacting bod-
ies are glued perfectly to each other. The frictional contact is highly
nonlinear and it is computationally intensive compared to boned contact.
Bonded contact is used for the contact between crown-cement layer,
cement layer-abutment, abutment-fixture, cancellous bone-cortical bone.
The contact between the crown and the opposing tooth is considered
frictional which allow for slides and space formation in order to approach
a real situation. Moreover, the effect of contact type between fixture
and peri-implant bone is studied. Since the friction coefficient is not
known, the effect of friction coefficients between the indenter and
occlusal surface on stress distribution is determined. FEA simula-
tions results show that friction coefficients ranging [0.1-0.4] have
no significant effect on the stress distribution in the crown. On the
other hand, choosing bonded contact between the occlusal surface
and the indenter, due to it is less requirement of computational
effort, might lead to different stress distribution in the crown and
large error in transferring the occlusal load to the surrounding tis-
sues. The maximum principal stresses in the crown for bonded con-
tacts ranges between [4.6 MPa, −4.8 MPa]. For frictional contact,
the maximum principal stresses, for all studied friction coefficients,
ranges between [9.3 MPa, −77 MPa].
10
F I G U R E 9 Min principal strain comparison. A, Titanium implant and abutment. B, titanium implant and CFR-PEEK abutment. C, CFR-PEEK
implant and titanium abutment. D, CFR-PEEK implant and abutment. E, titanium implant and LD abutment. LD, lithium disilicate
Almost identical stress distributions in the prosthetic components
for the five models studied are predicted by FEA. Moreover, the dif-
ferent materials for the implant/abutment did not alter the load trans-
fers to the surrounding tissues. However, it was expected a better
load distribution to the implant/abutment by the CFR-PEEK abut-
ments, once this material has an inferior young modulus than titanium.
As mentioned previously, for the five models studied, the maximum
tensile stresses in the cortical bone are equal to 33 MPa, while the
maximum compression ranges between 38 and 42 MPa. These find-
ings agree very well with previous studies. Moreover, these unex-
pected results agree with previous studies that tested
polyoxymethylene in the dental implant.17,36-38 The reasons behind
these unexpected results could be summarized as follows; the static
analysis does not consider the shock absorption capability of the rela-
tively softer material like PEEK. Moreover, the implant-bone interface
is assumed identical for all implant materials studied. Due to the lower
modulus of elasticity for the PEEK, larger deformation is expected
under load compared to their metallic counterpart, hence, larger con-
tact area between the bone and the implant surface, which leads to
lower stress distribution. This agrees well with another experiment 36
that evaluated the stress distribution by photoelastic analysis. The
result that a non-axial load is more harmful to the dental implants than
BATAINEH AND AL JANAIDEH
an axial load is supported by previous studies17,37 utilizing 3D finite
element analysis, and nonaxial loads were determined to result in
higher stress levels in the peri-implant bone than the axial loads. The
same was observed in a study with finite element study, as the stress
concentration in the bone and components of the implant system was
determined to be higher when subjected to sidelong loads than verti-
cal loads. Our results presented here confirmed this data when the
simulation was performed with the oblique load, as shown in Table 4.
The adhesion properties of the bone to the implant surface plays a
significant role. Finite element simulations are carried out to investi-
gate the effect of physical interaction between the fixture and peri-
implant bone. Perfect bonding between the implant surface and the
bone results to localized area of high stress and strain concentrations.
On the other hand, allowing slight sliding motion between bone and
implant (slight physiologic movement of teeth), FEA results predict
much better strain and stress distribution at the bone-implant inter-
face. The sliding motion allows redistributing the stress and the strain
in the supporting bone. Strains induced in the bone for the perfect
bonded case are six times larger than that when sliding movement is
allowed. Introducing part periodontal ligament allows a slight physio-
logic movement of teeth; thus, absorbed the impact of excessive load.
BATAINEH AND AL JANAIDEH
In the current study, the highest tensile and compressive stress
values occurred in the cortical bone of the upper bone-implant inter-
face and never in the cancellous bone. This finding agrees well with
several other studies which also investigated the influence of occlusal
load on the implant-bone interface by finite element analysis.26-28 The
cortical bone with the higher Young's modulus reacts as a fulcrum
under oblique load and absorbs higher load than the cancellous
bone.27 Moreover, FEA ref this current study confirm that occlusal
overload primarily affects regions around the implant neck.
For all models studied, and the type of contact between the fix-
ture and the bone, the amount of strains easily exceeds 0.0035 under
the amount of oblique load used in this study. Applying principles of
Frost's mechanostat theory to the alveolar bone, finite element results
for strains in peri-implant bone due to oblique loads, predict patholog-
ical bone failure. These findings do not agree with the clinical observa-
tions that dental implants have a high rate of success. It can be argued
that the principles of Frost's mechanostat theory suitable for long
skeletal bones cannot be applied to alveolar bone, or the different
classifications of strain thresholds should be determined for
alveolar bone.
6 | CO NC LUSIO N
The aim of this study is to investigate the advantages of substituting tita-
nium by CFR-PEEK in implant prosthesis. The comparison between the
performance of different implant prosthesis materials is investigated using
finite element method under excessive oblique load. The load transfers to
the peri-implant and stress distribution in peri-implant bone due to exces-
sive oblique load are evaluated. Large number of elements is needed for
accurately modeling due to complex shape of the dental implant. Friction
coefficients ranging [0.1-0.4] have no significant effect on the stress dis-
tribution in the crown and the rest of implant prostheses, while choosing
bonded contact between the occlusal surface and the indenter leads to
inaccurate stress distribution in the crown and large error in transferring
the occlusal load to the surrounding tissues. The principle of Frost's the-
ory is used as general guidelines for predicting peri-implant bone failure.
The effect of physical interactions between several contacting bodies are
determined. More specifically, the effect of contact types between occlu-
sal surfaces on load transfer is investigated. Moreover, the effect physical
interface between the fixture and surrounding bones on stress distribu-
tion in peri-implant bone is determined. The effect of friction coefficients
between the indenter and occlusal surface and between implant and pre-
implant bone on stress distribution are determined. Current FEA results
agree with previously published work. The highest maximum and lowest
minimum principal stresses were always located in the cortical bone and
never in the cancellous bone which is consistent with the existing litera-
ture. Off-axis loading can result in unfavorable forces on the implant,
jeopardizing the long-term success because of excessive lateral loads.
Moreover, the effect physical interface between fixture and surrounding
bones on stress distribution in peri-implant bone is determined. Finally,
the strain thresholds of Frost's mechanostat theory that are suitable for
long bone could not be applied for alveolar bone.
11
CONFLIC T OF INT ER E ST
The authors declare there is no conflict of interest of publishing this
material.
OR CID
Khaled Bataineh https://orcid.org/0000-0002-5809-042X
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How to cite this article: Bataineh K, Al Janaideh M. Effect of
different biocompatible implant materials on the mechanical
stability of dental implants under excessive oblique load. Clin
Implant Dent Relat Res. 2019;1–12. https://doi.org/10.1111/
cid.12858