Applied Mathematical Modelling 35 (2011) 446–456

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Applied Mathematical Modelling

journal homepage: www.elsevier.com/locate/apm

Optimum selection of the dental implant diameter and length in the

posterior mandible with poor bone quality – A 3D finite element analysis
Tao Li a,1, Kaijin Hu b,1, Libo Cheng c, Yin Ding a, Yuxiang Ding b,**, Jinling Shao a,*, Liang Kong b
a
Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, PR China
b
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, PR China
c
Department of Fluid Machinery and Engineering, School of Energy and Power Engineering, Xi’an jiaotong University, Xi’an 710049, PR China

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

Article history: This study aimed to evaluate continuous and simultaneous variations of dental implant
Received 23 September 2007 diameter and length, and to identify their relatively optimal ranges in the posterior mandi-
Received in revised form 1 June 2010 ble under biomechanical consideration. A 3D finite element model of a posterior mandibu-
Accepted 5 July 2010
lar segment with dental implant was created. Implant diameter ranged from 3.0 to 5.0 mm,
Available online 27 July 2010
and implant length ranged from 6.0 to 16.0 mm. The results showed that under axial load,
the maximum Von Mises stresses in cortical and cancellous bones decreased by 76.53% and
Keywords:
72.93% respectively, with the increasing of implant diameter and length; and under bucco-
Dental implant
Finite element analysis
lingual load, by 83.97% and 84.93%, respectively. Under both loads, the maximum displace-
Implant diameter ments of implant-abutment complex decreased by 58.09% and 75.53%, respectively. The
Implant length results indicate that in the posterior mandible, implant diameter plays more significant
Posterior mandible roles than length in reducing cortical bone stress and enhancing implant stability under
Bone quality both loads. Meanwhile, implant length is more effective than diameter in reducing cancel-
lous bone stress under both loads. Moreover, biomechanically, implant diameter exceeding
4.0 mm and implant length exceeding 12.0 mm is a relatively optimal combination for a
screwed implant in the posterior mandible with poor bone quality.
Ó 2010 Elsevier Inc. All rights reserved.

1. Introduction

Over the past several decades, dental rehabilitation with implants has been widely accepted by dentists and patients be-
cause of its reliable functional and aesthetic results. So far, dental implant has turned out to be a great success in long-term
clinical applications with a survival rate of over 90% [1]. However, in the posterior mandible with poor bone quality, the sur-
vival rate of implants is much lower [2]. It is difficult to estimate the optimal primary stability in the posterior mandible,
which leads to high implant failure rates [3].
The success of dental implant is related to the quality and quantity of jaw bones, implant design, implant surface texture,
surgical procedures and so on [4]. Among the implant designs, implant diameter and length have been intensively studied
and well accepted as key factors, since they directly influence the primary stability, placement, and removal torque values of
dental implant [4]. Horiuchi et al. [5] suggested that implants should be at least 10 mm long to ensure a high success rate.

* Corresponding author. Address: Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road,
Xi’an 710032, PR China. Tel.: +86 29 84776137; fax: +86 29 84776131.
** Corresponding author.
E-mail addresses: yxding@fmmu.edu.cn (Y. Ding), implant@fmmu.edu.cn (J. Shao).
1
These authors contributed equally to this work and should be regarded as co-first authors.

0307-904X/$ - see front matter Ó 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.apm.2010.07.008
 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456 447

Chiapasco et al. [6] proposed that it would be better to use implants more than 14 mm in length and more than 4 mm in
diameter. However, most of the previous studies were focused on the regions with normal bone quality. So far, few studies
have been designed to investigate dental implant diameter and length in the posterior mandible with poor bone quality.
Bone quality varies greatly in different regions of anatomy in mandible. Mandible tends to decrease in its cortical thick-
ness but increase in its trabecular porosity as it moves posteriorly [7]. In elder people and osteoporosis patients, the posterior
mandibles are mostly composed of type IV bones, classified by Lekholm et al. [8]. Type IV bone is characterized as a thin layer
of cortical bone surrounding a core of low-density and poor-strength trabecular bone [8]. Previous studies have showed that
the amount of cancellous bone does not increase implant stability at time of surgery [9], while the thickness of cortical bone
strongly increases implant stability [3]. Posterior jaws are the main functional area of masticatory activity, and most tooth
losses take place in this region [10]. However, few studies have been specially designed in this position. Effects of implant
diameter and length on bone stress distribution and implant stability in this region remain unclear. Moreover, the optimal
ranges of implant diameter and length are hard to define. Therefore, it is necessary to understand the role of implant diam-
eter and length in the posterior mandible with poor bone quality.
The finite element method in the analysis of implant biomechanics provides many advantages over other methods in sim-
ulating the complexity of clinical situations. It can be used to predict stress distributions in jaw bones and displacements in
implants. However, most of the previous finite element studies examined the effect of implant parameters discretely and inde-
pendently. Therefore, the information about implant parameters was not accurate, and some important information might
have lost [11]. This study aimed to evaluate continuous and simultaneous variations of dental implant diameter and length,
and to identify their relatively optimal ranges in the posterior mandible with poor bone quality from the perspective of
biomechanics.

2. 3D finite element modeling

2.1. Model design

A posterior mandibular segment with a screwed dental implant and a superstructure was modeled on a personal com-
puter with a 3D program (Pro/E Wildfire, Parametric Technology Corporation, USA) (Fig. 1). A cross-section of the mandible
in the first molar region, obtained from CT scanning, was used as the basis for a solid model. This section contained a thin
layer of cortical bone surrounding a core of low-density and poor-strength trabecular bone, i.e., type IV bone according to the
Lekholm and Zarb classification [8]. The average thickness of the cortical bone in the crestal region was 1.0 mm according to
the measurement by Dicom software. The mesio and distal section planes were not covered by cortical bone. Fig. 2 shows the
dimensions of the bone segment.
The geometry of the ITIÒ (Institute Straumann, Basel, Switzerland) solid implant was used as a reference to model a
cylindrical screwed dental implant and a 3.5-mm high solid abutment. The implant and the abutment were simplified to
one unit (Fig. 2) [11]. A profile of a full porcelain superstructure (mandibular first molar) was achieved by 3DSS (Three
Dimensional Sensing System, Caohejing High Tech. Park, Shanghai Digital Manufacturing Corporation, China) using structure
light scanning technique. The solid model was reconstructed using the scanning data by a reverse engineering program
(Geomagic Studio 8.0, Raindrop Geomagic, Inc., USA). Then the superstructure model was applied over the titanium
abutment by Pro/E program (Fig. 1). Implant diameter (D) and length (L) were set as input variables. D ranged from 3.0
to 5.0 mm, and L ranged from 6.0 to 16.0 mm. All the models were meshed and analyzed by Ansys Workbench10.0 (SAS
IP, Inc., USA).

Fig. 1. The 3D finite element model and load directions. (a) AX load, and (b) 45° BL load.
448 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456

Fig. 2. A cross-sectional view of the symmetry plane in a model. (a) Superstructure, (b) implant and abutment, (c) cancellous bone, and (d) cortical bone.

Fig. 3. A 4-node tetrahedral element.

2.2. Mathematical statement of the finite element model

The general steps of the finite element analysis, including structure discretization, element analysis and total analysis, are
used. According to the basic concepts of the finite element analysis, a tetrahedral element can be calculated (Fig. 3). The dis-
placement vector can be represented as
2 3
u
6 7
r ¼ 4 v 5 ¼ Nde ¼ ½ IN i INj INm IN p de ; ð1Þ
w
where r, de, I and Ni are the elemental displacement, nodal displacement, third-order unit matrix and shape function, respec-
tively. u, v and w are three translational displacements. Ni is given by
ai þ bi x þ ci y þ di z
Ni ¼ ði; j; m; pÞ; ð2Þ
6V
 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456 449

Table 1
Mechanical properties of the materials used in the 3D finite element models.

Materials Young’s modulus (MPa) Poisson ratio References

Cortical bone 13,000 0.30 [12]
Cancellous bone 690 0.30 [12]
Titanium 102,000 0.35 [13]
Porcelain 68,900 0.28 [13]

where ai, bi, ci and di are coefficients related to x, y and z. V is the tetrahedron’s volume. During solving the pace stress prob-
lems, every node has six strain components, which can be written as
h iT
ov
e ¼ ½ ex ey ez exy eyz exz  ¼ ou
ox oy
ow
oz
ou
oy
þ ooxv ov
oz
þ ow
oy
ow
ox
þ ou
oz ; ð3Þ

where e is the total strain vector. ex and exy are the typical terms for the direct strain in the x-direction and shear strain in the
x–y-plane, respectively. The relationship between stress and strain can be represented as

r ¼ ½ rx ry rz rxy ryz rzx de ¼ Sde ¼ DBde ; ð4Þ

where r, S, B, D are the total stress vector, stress matrix, strain–displacement matrix and elasticity matrix, respectively. rx
and rxy are the typical terms for the direct stress in the x-direction and shear stress on the x–y-plane, respectively. D depends
on the elastic constants E and l. Then the element’s stiffness matrix can be represented as

K e ¼ BT DBV: ð5Þ
Based on the principles of statics, the different types of forces, which have effects on the adjacent elements, should be trans-
lated into the equivalent load Pe. Based on the theory of elasticity, Pe can be calculated from

P e ¼ K e  r: ð6Þ
In order to ensure the calculation accuracy, minimize the number of element and improve the calculation speed, higher order
elements are used in this study. For the complex model here, when the whole model need to be calculated, all element stiff-
ness matrices need to be translated into one stiffness matrix, and then every nodal displacement could be calculated.

2.3. Material properties

All materials used in the modeling were assumed to be isotropic, homogeneous, and linearly elastic. Table 1 shows the
parameters of elastic properties [12,13].

2.4. Interface conditions

An osseointegrated implant was simulated with a screwed rough surface. During the simulation, a bond condition was set
at its interface with the mandibular bone [14].

2.5. Elements and nodes

The models were meshed with 10-node tetrahedral and 20-node hexahedral elements. A refinement mesh was generated
around the implant as shown in Fig. 4. On average, one model consisted of 260,000 elements and 370,000 nodes.

2.6. Constraints and loads

The models were constrained at the nodes on the mesial and distal bones in all directions. Forces of 100 N and 30 N were
applied axially (AX) on the fossa and 45° buccolingually (BL) on the buccal cusp, respectively [15]. Since in the Ansys Work-
bench DesignXplorer environment, the strain and stress response surface/curve of jaw bone demonstrated exactly the same
tendency with only differences in absolute vales, they might behaved in the same manner. The maximum Von Mises stress
(maximum equivalent stress, abbreviated Max EQV stress) in mandible and the maximum displacement (abbreviated Max
displacement) in implant-abutment complex were set as output variables to evaluate the effect of input variables on man-
dible and implant. Sensitivities of output variables to input variables were also evaluated.

2.7. Convergence tests

In this study, convergence tests with mesh refinements were performed. The Max EQV stress in mandible was used for
convergence monitoring, and a tolerance of 5% was employed. If a change was less than 5% of the Max EQV stress in both
450 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456

Fig. 4. A cross-sectional view of the symmetry plane in a meshed model.

Fig. 5. Chart of the optimum selection of the curve: Slight changing and minimal value of the curve.

cortical and cancellous bones, it was considered convergent. An adaptive convergence was achieved when the number of
mesh-refinement loops was set as two.

2.8. Response surface and sensitivity chart construction

Nine samples were analyzed for the response surface construction. In the DesignXplorer environment, the samples are
generated by the Latin Hybercube Sampling (LHS), which is a more advanced and efficient version of Monte Carlo Simulation
method that effectively avoids repetitive sampling. Compared with the Direct Monte Carlo Simulation technique, LHS re-
quires 20–40% fewer simulation loops to achieve the same results with the same accuracy. Moreover, local sensitivity charts
were generated by Ansys DesignXplorer to reflect the impact of input variables on output variables. The local single param-
eter sensitivity was calculated based on the difference between the minimum and maximum values obtained by varying the
input parameter of interest while keeping all the other input parameters constant. Thus, the obtained single parameter sen-
sitivity depended on the values of the input parameters that were held constant.

2.9. Optimum range selection

When a straight line is tangent to a curve, the slope rate of the straight line shows the changing frequency of the curve.
When the slope rate ranges from 1 to 1, it indicates slight changes of the output variable in response to the changes of the
input variable (Fig. 5). Therefore, the optimum implant parameters should be selected in this range [16].
 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456 451

Table 2
Max EQV stresses in maxilla (MPa) and Max displacement in implant-abutment complex (lm) of the samples.

Number D (mm) L (mm) Max EQV stress in cortical Max EQV stress in cancellous Max displacement in implant-abutment
bone (MPa) bone (MPa) complex (lm)
AX load BL load AX load BL load AX load BL load
1 3.0 6.0 28.525 35.769 2.288 2.194 7.662 14.126
2 3.0 11.0 26.000 37.705 1.447 0.871 5.882 12.147
3 3.0 16.0 19.855 34.295 1.141 0.837 5.038 11.916
4 4.0 6.0 18.006 15.190 1.650 1.517 5.971 8.157
5 4.0 11.0 13.024 11.437 0.997 0.579 4.572 6.466
6 4.0 16.0 11.174 9.573 0.816 0.408 3.902 6.190
7 5.0 6.0 11.780 11.706 1.235 1.074 4.824 5.599
8 5.0 11.0 8.369 8.449 0.805 0.499 3.739 4.325
9 5.0 16.0 7.389 8.144 0.625 0.348 3.206 4.016

Fig. 6. The EQV stress distribution in bone and displacement in implant (D = 4.0 mm and L = 11.0 mm). (a) EQV stress distribution in cortical bone under the
AX load; (b) EQV stress distribution in cancellous bone under AX; and (c) displacement in implant under AX; (d) EQV stress distribution in cortical bone
under the BL load; (e) EQV stress distribution in cancellous bone under BL; and (f) displacement in implant under BL.

3. Results and discussion

The success of dental implant depends on both endogenous and exogenous factors. Bone quality belongs to the endoge-
nous factors, and implant design is among the exogenous factors. All these factors will significantly affect implant success
rates [3]. In this study, the effect of implant diameter and length on the stress distribution in the posterior mandible with
poor bone quality and displacement in implant-abutment complex was investigated. Distinct from discrete variations in pre-
vious studies, we investigated continuous variations of the two investigated factors (D and L) as response surfaces and curves
and achieved more accurate and visualized results about implant parameters. All figures and tables in this study were auto-
matically generated by the Ansys Workbench DesignXplorer program.

3.1. Model design

In this study, we rebuilt a self-adaptive 3D model, which performed superior to traditional approaches in parameterized
self-changing implant model constructing, self-adaptive 3D models assembling, bidirectional parameters transmitting and
452 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456

Table 3
Response surfaces of output variables to input variables. Decreased percentage = (ValueMax  ValueMin)/ValueMax  100%.

AX load BL load
Max EQV stress in cortical bone (MPa)

Decreased percentage 76.53 83.97

Max EQV stress in cancellous bone (MPa)

Decreased percentage 72.93 84.93

Max displacement in implant-abutment
complex (lm)

Decreased percentage 58.09 75.53

variables settings. Parameterized self-changing implant model constructing means the implant model is constructed based
on implant diameter and length. In other words, the number of implant thread could change with the implant diameter and
length varying automatically. Self-adaptive 3D models assembling means all the models are rebuilt based on implant param-
eters. That is to say, the parameters of other parts (cortical and cancellous bones) changed with the parameters of implant
varying automatically. Bidirectional parameters transmitting means CAD (Pro/E) and CAE (Ansys Workbench) software could
transmit model’s parameters mutually and seamlessly. Variables settings include input variables (D and L) and output vari-
ables (Max EQV stress in mandible and Max displacement in implant-abutment complex). So, only one self-adaptive assem-
bled model was needed and the time of model regeneration and solving process was shortened.
It has been shown that the simulation results may vary dramatically if the boundary conditions such as fixed bond, slip
contact and nonlinear contact were set differently [11]. However, experimental evidence remains too limited to decide the
most realistic interface boundary condition [17]. Removal of implants with rough surfaces frequently results in fractures
within the bone far from the implant surface [18], suggesting the existence of an implant-bone ‘‘bond”. Since this study sim-
ulated an osseointegrated implant with a screwed rough surface, a fixed bond condition was set between the interface of
implant and bone, as an approximation.

3.2. Stress and displacement distributions

Table 2 lists Max EQV stresses in mandible and Max displacements in implant-abutment complex of the nine samples.
The distributions of EQV stress in cortical, cancellous bones and implant displacements were similar through the full range
Table 4
Response curves of Max EQV stress in mandible to input variables. Decreased percentage = (StressMax  StressMin)/StressMax  100%.

AX load BL load
Cortical bone Cancellous bone Cortical bone Cancellous bone
D (3.0–5.0 mm) (L = 11.0 mm)

T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456

Decreased percentage 63.15 45.83 77.99 46.07
Optimum selection D P 3.6 mm D P 4.0 mm D P 3.9 mm D P 3.6 mm
L (6.0–16.0 mm) (D = 4.0 mm)

Decreased percentage 35.67 51.52 25.53 69.93

Optimum selection – L P 9.3 mm L P 9.3 mm L P 9.3 mm

453
454 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456

Table 5
Response curves of Max displacement in implant-abutment complex to input variables. Decreased percentage = (DisplacementMax  DisplacementMin)/
DisplacementMax  100%.

AX load BL load
D (3.0–5.0 mm) (L = 11.0 mm)

Decreased percentage 36.39 67.30

Optimum selection D P 3.8 mm D P 4.0 mm
L (6.0–16.0 mm) (D = 4.0 mm)

Decreased percentage 34.67 27.48

Optimum selection L P 9.5 mm L P 12.0 mm

surveyed, so only one model (D = 4.0 mm, L = 11.0 mm) was shown in Fig. 6. The results were similar to previous reports [11].
Because of a great difference between the stress values in cortical and cancellous bones, the stress distributions in the two
regions are shown separately for better visualization. The EQV stresses in cortical bone were around the implant neck under
both AX and BL loads (Fig. 6a and d). The EQV stresses in cancellous bone were around the implant thread and the Max EQV
stresses were concentrated in the implant tip under both loads (Fig. 6b and e). The difference of stress distribution in man-
dible between AX and BL load was that EQV stresses under BL load were buccally deflected (Fig. 6b and d). The displacements
in implant were concentrated in the implant abutment under both loads and the Max displacements were in the top of im-
plant abutment (Fig. 6c and f). Contrary to the EQV stress distribution in mandible, implant displacement under AX load was
buccally deflected (Fig. 6c).

3.3. Bivariate analyses

Table 3 presents the response surfaces of output variables to input variables under both AX and BL loads. With the
increasing D and L, the response surfaces showed dramatic decreasing tendencies of Max EQV stress in mandible and
Max displacement in implant-abutment complex under both loads. The descending ranges of Max EQV stress in cortical
and cancellous bones are similar, which are higher than those of Max displacement in implant-abutment complex under
both loads, respectively. Compared with AX load, the descending ranges of output variables under BX load are higher.

3.4. Univariable analyses

Tables 4 and 5 present the response curves of one output variable vs. input variables, given the other input variable was
equal to the median, which allowed the optimal range selected [11]. The response curves showed rapid decreasing tenden-
cies with the increasing of D and L, respectively. These data suggested that the most stable and minimal level of stress and
displacement value could be achieved when D exceeded 4.0 mm and L exceeded 12.0 mm. The optimal ranges of D and L in
the posterior region with poor bone quality are different from that in other regions of jaw bone with relatively normal bone
quality [5], indicating the specificity of this region.

3.5. Sensitivity analyses

The sensitivities of output variables to input variables are similar through the full range surveyed, and thus only one sen-
sitivity chart (D = 4.0 mm, L = 11.0 mm) was shown in Fig. 7. These results indicated that D played more significant roles than
 T. Li et al. / Applied Mathematical Modelling 35 (2011) 446–456 455

Fig. 7. Sensitivity analysis of output variables vs. input variables (D = 4.0 mm and L = 10.0 mm). (a) Max EQV stress in cortical bone under the AX load; (b)
Max EQV stress in cancellous bone under AX; (c) Max displacement in implant-abutment complex under AX; (d) Max EQV stress in cortical bone under the
BL load; (e) Max EQV stress in cancellous bone under BL; and (f) Max displacement in implant-abutment complex under BL.

L in reducing cortical bone stress and enhancing implant stability under both AX and BL loads. Meanwhile, L was more effec-
tive than D in reducing cancellous bone stress under both loads.

3.6. Limitations

While our study provides doctors and patients important insights in the prognosis of dental implant in the posterior man-
dible with poor bone quality, it should be noticed that our results were given with several assumptions about the properties
of materials and simplified models in the finite element analysis. Therefore, the results we obtained should be considered as
a reference to select implants in the clinical treatment. Prospective clinical studies are required to verify the results.

4. Conclusions

From our study, several interesting points could be drawn from the perspective of biomechanics.

1. Stress in the posterior mandible with poor bone quality is influenced by both implant diameter and length. Moreover,
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 under both AX and BL loads.
2. Biomechanically speaking, implant diameter exceeding 4.0 mm and length exceeding 12.0 mm are a relatively optimal
selection for a screwed dental implant in the posterior mandible with poor bone quality.

For further studies, the model can be improved by using anisotropic materials in jaw bone and choosing better interface
boundary condition between the interface of implant and bone. Moreover, the loading scenario could be modified according
to the clinical situation to get more reliable results.

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