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    Biomechanical Effect of Implant Design on Four Implants Supporting Mandibular Full-Arch Fixed Dentures_ in&Nbsp;Vitro Test and Finite Element Analysis _ Elsevier Enhanced Reader

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    Biomechanical Effect of Implant Design On Four Implants Supporting Mandibular Full-Arch Fixed Dentures - In&nbsp Vitro Test and Finite Element Analysis - Elsevier Enhanced Reader

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    Mario Troncoso Andersenn

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    Journal of the Formosan Medical Association xox (xc) 0 Available online at www sciencedirect.com ScienceDirect journal homepage: www./fma-online.com Original Article Biomechanical effect of implant design on four implants supporting mandibular full-arch fixed dentures: In vitro test and finite element analysis Aaron Yu-Jen Wu ®, Jui-Ting Hsu °°, Lih-Jyh Fuh °, Heng-Li Huang *°*"' * Department of Dentistry, Chang Gung Memorial Hospital & College of Medicine, Chang Gung University, Taiwan ® School of Dentistry, China Medical University, Taichung, 40402, Taiwan © Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan Received 26 September 2019; received in revised form 26 November 2019; accepted 9 December 2019 KEYWORDS ‘Background! Purpese: Impact of the implant shape on the biomechanical performance of all: Pitunttate etre ‘on-four treatment of dental implant is still unclear. This study evaluated the al-on-four treat: with four ment with four osseointegrated implants in terms of the biomechanical effects of implant Peccontegrated) 10 mm) to be used, thereby substantially increasing the bone-to-implant contact area. Good success rates of this treatment concept after 3 and 7 years have been verified. ° Moreover, other dentists who used the Brénemark system implants also confirmed good success rates for the all-on-four treatment concept over a S-year period.” The implant design in a single-tooth implant affects the stress and strain distributions in the surrounding bone."°-"" Dental implants are in direct contact with bone, and so changing the shape of an implant can directly affect the transmission of occlusal forces from the implant to the bone, and may change the distributions of stress and strain in both the implant and the surrounding bone. Higher stress and strain in the bone around an implant resulting from coverioading may increase the risk of the damage to the bone or marginal bone resorption. * "° However, only a few researchers’ have evaluated the impact of the implant, shape on the biomechanical performance of all-on-four treatment. Selecting an implant system is one of the most- {important decisions in the surgical planning of all-on-four treatment, and this decision might influence the stresses, and strains in the surrounding bone. Therefore, the purpose Of this study was to determine how the implant designs in all-on-four treatment influence the stress and strain dis- tributions in an implant and surrounding bone when, ‘occlusal loads are applied in the canine, premolar, and molar regions. Both in vitro strain gauge tests and three- dimensional (3D) finite element (FE) simulations were per- formed in the present study to explore this issue. Materials and methods In vitro experimental test ‘A synthetic jawbone model (#8571, Synbone AG, Malans, Switzerland) with mild atrophy was selected as the bone sample of the edentulous mandible. This synthetic jawbone is anatomically and biomechanically similar to real bone, comprising a dense outer layer replicating the cortical shell and a porous inner content that simulates cancellous bone. (One major advantage of using synthetic jawbone is that it avoids the associated ethical issues,"” as well as errors associated with differences in appearance between individuals. ‘Two kinds of implant designs were chosen for the ana- lyses (ig. 1): NobelSpeedy (Nobel Biocare AB, Goteborg, ‘Sweden) and NobelActive (Nobel Biocare AB). Both of these —— = —— —— —s —— —— oy NN Figure 1 implants, Nobelspeedy (left) and NobelActive (right) ijfma.2019.12,001 Please cite this article as: Wu AV-J etal, Biomechanical effect of implant design on four implants supporting mandibular full-arch fixed dentures: In vitro test and finite element analysis, Journal of the Formosan Medical Association, ttps://dol.org/10.1016/ Effects of implant design in all-on-four implant treatment 3 implants have a diameter and length of 4 mm and 11.5 mm, respectively, and the terms "Speedy" and “Active” are used henceforth to represent the variants for the sake of brevity. ‘Abutments for use with these two implant systems were also prepared. In the anterior region of the mandible, two implants with straight abutments (Multi-unit Abutment, Nobel Bio- care AB) were embedded axially and bilaterally. Two tilted implants with special 30° angled abutments (30° Mult-unit Abutment, Nobel Biocare AB) were placed at approximately 30° to the occlusal plane in the posterior region of the mandible bilaterally. The tilted implants were positioned about § mm anterior to the foramina. A custom-made ti- tanium framework was then attached to the abutment with titanium screws (Nobel Biocare AB) above the four im- plants. The cantilever was about 20 mm long, and the dis- tance between the anterior axial implants and the posterior tilted implants was about 25 mm (Fig. 2). Rectangular rosette strain gauges (KFG-1-120-D17-11L3M3S, Kyowa, ‘Tokyo, Japan) were attached to the buccal side of the crestal cortical bone around the implant using cyanoacry- late cement (CC-33A, Kyowa) (Fig. 2) ‘A self-developed jig was designed and manufactured to constrain the full jawbone model on the testing platform of a loading machine (JSV-H1000, Japan Instrumentation Sys tem, Nara, Japan). The rationale of this special jg is to use the three-point holding method to fix the regions between the condylar and coronoid process as well as the mental protuberance. Therefore, the sample can be fixed on the machine for load testing. The direction of loading could be adjusted using a rotational screwing device inside the jig. fein: fide a nM Figure 2 _in vitro experimental model including the artifical, Jawbone, four implants, framework, and rectangular rosette strain gauges. The numbers indicate leadingpositions 1,2, and3. Three kinds of loading conditions were produced using ‘the model: loading position 1 was a vertical static load applied to the middle of the incisor area of the framework, while loading positions 2 and 3 were the same loads applied to the framework close to the posterior tilted implant with and without a cantilever, respectively (Fig. 2). The maximum force was 100 N and the head speed was 1 mm/ min for each loading position (Fig. 3a). The signals corresponding to the three independent strains &, e%, and ec on the rosette strain gauge were detected by 2 data acquisition system (NI CompackDAQ, National Instruments, Austin, TX, USA) and the associated software (LabVIEW SignalExpress 3.0, National Instruments), {as each load was applied (Fig. 3b). After each measurement had been repeated five times for each sample, the maximum (emax) and minimum (ény9) principal strains were obtained as follows: eax = 1/2(eu+6e)+1/2VU(6—€e)? (200-2 ee)] a Emin = U2(eatee)—1/2y Kleaee)?+(Ree~eo ee] @ The peak values of tax and cmin around the implant under each loading condition were recorded. Due to the consideration of small sample sizes, all the measured data were summarized as median and interquartile-range (IQR), values. Then wilcoxon's rank-sum test was used to compare the measured data between the two implant designs in the all-on-four treatment. All of the statistical analyses were Performed using commercial statistical software (SAS version 9.1, SAS Institute, Cary, NC, USA), with an alpha value of 0.05. 3D FE modeling The 3D structure of a mandible with mild atrophy was ob- tained from a series of cone-beam computed tomography (CBCT) images of the same synthetic jawbone model (#8571, Synbone AG) using the Mimics medical imaging software (version 15.0, Materialise, Leuven, Belgium). 3D models of the Speedy and Active implants, their straight ‘and angled abutments, and the customized framework were developed using computer-aided design (CAD) soft: ware (SolidWorks 2017, SolidWorks Co., Concord, MA, USA) (Fig. 4a, b). The detail geometries of the implant features including thread shape, thread pitch, thread depth ... etc, were all from the catalog provided from the website of the manufacturer and actual measurement from the real parts, of the implants. After the bone model was imported into the CAD software, Bootean operations were performed, all of the 3D models were combined in an assembly procedure (Fig. 4c), and the abutment and implant were set as an integral component. After the 3 modeling procedure was complete, all of the experimental models were exported to, commercial FE analysis software (ANSYS Workbench, ‘Swanson Analysis, Huston, PA, USA). Ten-node tetrahedral h-elements (ANSYS. SOLID187) were used to generate the FE model. In order to obtain, accurate results with an acceptable computation time, el ‘ements of different sizes were used in the FE model; for ‘example, the elements within the area of interest close to ijfma.2019.12.001 Please cite this article as: Wu AV-J et al., Biomechanical effect of implant design on four implants supporting mandibular fall-arch fed dentures: In vitro test and finite element analysis, Journal of the Formosan Medical Association, ttps://dot.org/10.1016/ Figure 3 (a) The experimental model with the full jawbone constrained by the self-developed jig. The jig was fixed to the platform of the loading machine so that a load could be applied to the experimental model at each loading position. (b) The entire in vitro experimental equipment used in this study. (a) (b) (c) (a) Figure 4 (a) The 3D CAD models of the Active implant (left) and the Speedy implant (right). (b) Two straight and two tilted implants were fixed to the customized framework and (c) were placed in the jawbone model. (4) The generated FE model ‘comprised elements of different sizes, The implants, framework, and bone region close to the implants were meshed using ele- ments with a size of only 0.5 mm. the peri-implant bone were as small as 0.5 mm (Fig. 4d). The material properties of all the model components The number of the element and nodes of the models with are listed in Table 1."""""° The implants, abutment, Active implants were 782095 and 1279726 as well as those framework, and bone were assigned to be homogeneous with Speedy implants were 883927 and 1443010. and have ‘isotropic elastic properties. The interface Please cite this article as: Wu AV-J etal, Biomechanical effect of implant design on four implants supporting mandibular full-arch fixed dentures: In vitro test and finite element analysis, Journal of the Formosan Medical Association, ttps://dol.org/10.1016/ ijfma.2019.12,001 Effects of implant design in all-on-four implant treatment Table 1 Material properties inthe FE model ° eso ss ater Yourd’s modus Poisonsratio geen saee gorges Sone rs & | JRF ease atecse 74 Cortical bone 14800, 03 3 3 5 ies Pe Fiatecttar fone 20 03 <2 gen gheSSee~ sees Titanium (implant) 110000 035 2e|_luolsT asa eT TSF ses 5F49 roan a. (framework) se Rose Ge 4 ics Eg So aesoFl esas yess 15 (lagna eisee3ct between the bone and implant was set as bonded (ie, § & ee eer assuming 100% osseointegration). The loading and *8| lle aacel TS 1e2Sai7 boundary conditions of the FE models were set to be £B Similar v0 those epplied in the In vitro experimental «2 8| | | @ | me a 33 tests. A vertical load of 100 N was applied individually at SesdensF eke anges loading positions 1, 2, and 3. The surface of the condyle Eg] |e/S mS ral i iaaaey y was fixed to zero displacement in the x, y, and zdi- g &| : ae rections as the boundary condition. sh eer ohoge yd Results ogy G8] | lofnconddsdnaaedt In vitro test 23) lo/STSsaaTT AT age eT 7 £3 ‘able 2Usts the maximum and minimum principal strains | Ee ace otal in the bone around each implant. The absolute valueof 2 2/ |aizS Quagitsitrssgi a minimum principal bone strains were higher than the ge maximum principal bone strains, which indicated that the 8 © eS ae) ee tee bone “seer the mnnant opertnced’ a, qroter ere Rees a compressive strain when force was applied at loading _] o|FTatea TT STSat sit positon 1,2, or. a? The peak bone strain was about 47% higher for loading © 5) See ee position 3 than for loading position 2, and at least 572 2B ee eet ae Trap al higher for loading position 1 (Fig. 5). The peak bone strain $8) JU} TIF e Te 1 IST RRS TT did not differ significantly between the Active and Speedy = S| ~ implants fr toaging postion 2or3,vnie twas 3 ower al e ans oy for the Speedy implant than the Active implant for loading 2 2 BARNS SSR eA one BR position 1 (Fig. 5) (p < 0.001). Ba] fo[TTSTT ST TST Sees 7 A aI eal

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