Materials Today: Proceedings: Shipra Gupta, Parveen Goyal, Ashish Jain, Priyanka Chopra

Materials Today: Proceedings xxx (xxxx) xxx
Contents lists available at ScienceDirect
Materials Today: Proceedings

journal homepage: www.elsevier.com/locate/matpr
Effect of peri-implantitis associated horizontal bone loss on stress

distribution around dental implants – A 3D finite element analysis
Shipra Gupta a,⇑, Parveen Goyal b, Ashish Jain c, Priyanka Chopra d
a
Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
b
Dept. of Mechanical Engineering, University Institute of Engineering &Technology, Chandigarh 160014, India
c
Dr. Harvansh Singh Judge Institute of Dental Sciences, Chandigarh 160014, India
d
Faculty of Dental Sciences, Shree Guru Govind Singh Tricentenary University, Gurgaon 122006, India
a r t i c l e i n f o a b s t r a c t
Article history: Bone loss due to Peri-implantitis leads to a decrease in the length of implant in contact with bone at any
Received 18 March 2020 given time. This further is expected to create a scenario wherein there are higher stresses at the bone–
Received in revised form 28 March 2020 implant interface. Failure to adopt corrective measures to treat the same can hence lead to implant failure
Accepted 28 April 2020
due to mechanical overload. Geometric models were generated for parallel walled dental implants with
Available online xxxx
V-shaped threads, placed in mandibular molar area in fully and partially osseo integrated situations cor-
responding to Implant-bone assemblies simulating various levels of horizontal bone loss. Functional
Keywords:
occlusal load of 118.2 N and maximal occlusal load of 275 N were applied at an angle of approximately
Dental implant
Biomechanics
75 degrees to the occlusal plane and biomechanical analysis was performed. Peak values of correspond-
Stress analysis ing von Mises stress were recorded. At attempt was also made to assess the occlusal loads which generate
Peri-implantitis ultimate stress in the cortical bone, and correlate them to the safety factor of load-carrying dental
Finite element analysis implants.
von Mises stress Ó 2020 Elsevier Ltd. All rights reserved.
Selection and peer-review under responsibility of the scientific committee of the International
Conference on Aspects of Materials Science and Engineering.
1. Introduction An implant is considered successful if there is only 1.5–1.8 mm

of bone loss during the first year after loading and thereafter not
Dental implants as a treatment modality, are highly predictable more than 0.2 mm bone loss annually [4]. However with such a
and aesthetic. They replace the lost natural teeth with ease, definition it is difficult for the clinician to distinguish the change
improving considerably the appearance and self-esteem of the from early to moderate to severe bone loss situations in case of Peri
patient [1]. However, as with natural teeth, dental plaque accumu- implantitis. A more practical and clinically relevant classification of
lation around them can lead to biological complications. American Peri-implantitis was given by Froum et al (2012) in which peri-
Academy of Periodontology (AAP) and the European Federation of implantitis is classified into ‘‘Early Peri-implantitis”, ‘‘Moderate
Periodontology (EFP) in their World Workshop on the Classifica- Peri-implantitis” and ‘‘Advanced Peri-implantitis” based on the
tion of Periodontal and Peri-Implant Diseases and Conditions con- length of the implant exposed by bone loss [5]. In situations where
ducted in 2017 defined Peri-implantitis as ‘‘a pathological the loss of bone is <25% of the implant length, is termed Early
condition occurring in tissues around dental implants, character- Peri-implantitis; from 25% to 50% of the implant length, Moderate
ized by inflammation in the peri-implant connective tissue and Peri-implantitis and >50% of the implant length, Advanced Peri-
progressive loss of supporting bone” [2]. Incidence of peri- implantitis.
implantitis has been reported to be between 28% and 56% by Plaque-induced bone loss leads to a smaller length of implant
Lindhe and Meyle (2008) [3]. being in contact with bone [6,7]. Hence once inflammation has
set in, mechanical overloading is bound adversely affect stresses
at the bone–implant interface [8–10]. In case the masticatory loads
remain the same, it is hypothesized that the implants would fail
⇑ Corresponding author. Tel.:+91-9876034881.
under these compromised circumstances. Stress has further been
E-mail addresses: gupta.shipra@pgimer.edu.in, shipra1472@gmail.com
shown to increase peri-implant bone loss in the presence of local
(S. Gupta).
https://doi.org/10.1016/j.matpr.2020.04.831
2214-7853/Ó 2020 Elsevier Ltd. All rights reserved.
Selection and peer-review under responsibility of the scientific committee of the International Conference on Aspects of Materials Science and Engineering.
Please cite this article as: S. Gupta, P. Goyal, A. Jain et al., Effect of peri-implantitis associated horizontal bone loss on stress distribution around dental
implants – A 3D finite element analysis, Materials Today: Proceedings, https://doi.org/10.1016/j.matpr.2020.04.831
2 S. Gupta et al. / Materials Today: Proceedings xxx (xxxx) xxx
etiological factors and ensuing inflammation, thereby setting up a

vicious cycle [11].
Analysing the stress transfer at the bone–implant interface in
order to understand the same in detail hence becomes imperative.
Finite element analysis (FEA) is considered to be an appropriate
computational tool for such simulation studies [12,13]. It measures
stress and deformation by breaking up the structure under study
into smaller units/domaims, carrying out computational opera-
tions for each unit and then compiling the data to give solution
for the whole structure, a process called discretization. The main
steps in any FE analysis are: making models using simulation soft-
ware programs like SolidWorks; importing the files into a FEA soft-
ware like ANSYS; allocating material properties to the models;
generating mesh with appropriate degrees of freedom; fixing
boundaries; applying loads as decided by investigator and finally,
Fig. 1. Implant assembly. carrying out the analysis to generate results in form of stresses
Table 1
Bone height dimensions for analysis of horizontal bone loss in an implant of 10 mm length.
Model Total Loss of bone Resultant length of implant in contact with bone Cortical bone loss (mm) Cancellous bone loss (mm)
Model 1 0 10 mm 0 0
Model 2 1 mm 9 mm 0.2 (10% of 2 mm) 0.8 (10% of 8 mm)
Model 3 2.5 mm 7.5 mm 0.5 (25% of 2 mm) 2 (25% of 8 mm)
Model 4 5 mm 5 mm 1 (50% of 2 mm) 4 (50% of 8 mm)
Fig. 2. Models under investigation (a) Model 1 (Non Resorption model); (b) Model 2 (horizontal bone loss up to 10% of implant length); (c) Model 3 (horizontal bone loss up to
25% of implant length); (d) Model 4 (horizontal bone loss up to 50% of implant length).
S. Gupta et al. / Materials Today: Proceedings xxx (xxxx) xxx 3
Table 2
Mechanical properties of materials under consideration [17–21].
Young’s Modulus Density Poisson’s ratio Tensile strength

3
Implant & Abutment TiAl4V 114 GPa 4.429 Kg/m 0.34 880 MPa
Type II Bone Cortical Bone (2 mm thick) 13.7 GPa 1.9 gm/cm3 0.3 100 MPa
Cancellous bone (dense) 1.37 GPa 0.3 gm/cm3 0.3 5 MPa
were made for 3.75 mm diameter and 10.0 mm length (Fig. 1).
Each implant model included a conical abutment of 5.5 mm height.
Implant and abutment were considered to be a single piece. The
occlusal load was applied to the abutment, right in the centre of
its upper surface.
Soft tissues were not modelled. The bone was modelled for both
cortical bone and cancellous bone, wherein the cortical bone
encased the cancellous bone as a shell. The cancellous bone was
assumed to be dense, mimicking Type II bone as described by
Lekholm and Zarb (1985) [14]. The thickness of cortical bone was
assumed to be 2 mm in all directions for the non-resorption model.
In resorption models, the thickness of the cortical bone on the crest
varied as described ahead.
The height, width and bucco-lingual thickness of the bone seg-
ment was assumed to be 22.5 mm * 20 mm * 12.5 mm respectively
(Demenko et al 2014) [15]. Implant systems were assumed to be
placed in the centre of bone segments.
Very few studies have analysed bone loss models. To the best of
my knowledge, no study till date has modelled defects in cancel-
lous bone. Once bone loss enters the picture, it is not only the cre-
stal cortical bone which is lost. Had that been the case then, defects
deeper than 2 mm would only have cancellous bone, which never
happens. In an attempt to make the models more realistic we
decreased the height of bone proportionally in both crestal cortical
Fig. 3. Mesh generation.
and cancellous bone (Table 1).
A total of 4 models were constructed. Horizontal bone loss was
simulated for each situation by assuming that a proportionate
Table 3 amount of both cortical bone (on occlusal end) and cancellous bone
Nodes & Elements of constructed models. are lost due to disease (Fig. 2a-d) corresponding to the bone loss
Model Nodes Elements situations as given by Froum et al (2012) [5]. The various versions
Model 1 1,256,031 876,573 of implant–bone assemblies under study are described below.
Model 2 1,573,844 1,108,443
Model 3 834,405 576,929 1. Model 1: Implant with no bone loss (bone level at time of
Model 4 2,114,401 1,505,590 loading) (Fig. 2a).
2. Model 2: Implant with horizontal bone loss upto 10% of
and strains [12,13]. It is an in silico analysis, done on computers, implant length (Fig. 2b).
attempting to mimic clinical situations as closely as possible. Many 3. Model 3: Implant with horizontal bone loss upto 25% of
FEA studies have been conducted on dental implants. However, implant length (Fig. 2c).
most of the studies around dental implants have focused on 4. Model 4: Implant with horizontal bone loss upto 50% of
Implant models with no bone resorption. Hence there is a need implant length (Fig. 2d).
for more realistic model generation where in bone loss of varying
levels could be incorporated and stress analysis performed. The The dimensions of the bone around the horizontal defect were
aim of this study was hence to conduct biomechanical analysis of hence assumed to be as per Table 1.
parallel walled dental implants with varying degrees of horizontal
bone loss due to Peri-implantitis. 2.2. Material properties
The next step was to import the solid models as .stp files into
2. .Materials & methods
ANSYS Workbench version 18.1 to construct the FEMs. (ANSYS
18.1, ANSYS Inc.). Assumptions made were: 1. Materials are lin-
2.1. Model design
early elastic and isotropic [16]; 2. Homogenous [16]; 3. The elastic
properties used were taken from the literature as shown in Table 2
Three-dimensional solid models of parallel walled dental
[17–21].
implants with V-shaped threads (built to the measurements of
Nobel Parallel Conical Connection Implants), were developed using
dimensions and high-resolution pictures given in the implant cat- 2.3. Elements & nodes
alogue and actual implants. SolidWorks Simulation Software 2018
(Dassault Systems Solid Works Corp.) was selected to create the FE mesh with appropriate number of degrees of freedom were
solid models. Models of mandibular first molar dental implants constructed (Fig. 3). Meshing was nonhomogeneous, as a finer
Fig. 4. Distribution of von Mises stresses (MPa) (a) Model 1–118.2 N (b) Model 1–275 N (c) Model 2–118.2 N (d) Model 2–275 N (e) Model 3–118.2 N (f) Model 3–275 N (g)
Model 4–118.2 N (h) Model 4–275 N.
mesh was generated around the neck of the implant in an attempt 2) Maximum occlusal force of 275 N at 75 degrees to the occlu-
to generate more accurate data. Depending on the model, elements sal plane, as reported by Mericske-Stern et al (1996) for
(4-node linear tetrahedral) and nodes were created as per Table 3. implants in molar region [24]. The forces vectors were:
266.62 N, in axial direction, 39.78 N in lingual direction,
2.4. Constraints & loading conditions and 54.44 N in distomesial direction.
3) Dimensional Finite element analysis was performed for assess-
Bone segment was considered fixed on both mesial and distal ing biomechanical behaviour of the implants with horizontal
aspects during the analysis so as to restrict body motion [22]. Load- bone loss at various stages of Peri-implantitis.
ing period was 1 s.
Loading of the implants, in 3D, was done with
3. Results and discussion
1) Functional occlusal load of 118.2 N at 75 degrees to the
occlusal plane as described by Himmlová et al. (2004) [23]. Stress patterns can be viewed as differently colored contour
The forces vectors were: 114.6 N in axial direction, 17.1 N lines. The equivalent stress distributions at the junction of implant
in lingual direction, and 23.4 N in distomesial direction. and cortical/cancellous bone under both loads for the non resorp-
Fig. 4 (continued)
tion model and resorption models can be appreciated in the Ultimate and Working masticatory forces should not be less than
Fig. 4(a-h). 2.0, this factor of safety was also determined in an attempt to guide
The Maximum von Mises stresses have been presented in the clinician as to the prognosis of the implant at that particular
Table 4 and pictorially in Figs. 5 & 6. Ultimate masticatory forces stage of Peri-implantitis.
which develop an ultimate stress of 100 MPa in adjacent cortical Maximum stress was found to be in the marginal bone at the
bone were also evaluated. As for dental implants the ratio between implant bone contact area for cortical bone and around the apex
Table 4
Maximum von Mises stresses, Ultimate masticatory forces and safety ratio of implants.
Maximum von Mises stress on Maximum von Mises stress on Ultimate masticatory Ultimate masticatory load/Working
application of 118.2 N (MPa) application of 275 N (MPa) force (N) masticatory force (Safety ratio)
Cortical bone Cancellous bone Cortical bone Cancellous bone
Model 1 9.6914 1.4557 22.55 3.2278 300 N 300/118.2 = 2.53
Model 2 19.161 1.0767 58.466 1.3111 325 N 325/118.2 = 2.75
Model 3 29.547 1.4224 87.846 3.5143 235 N 235/118.2 = 1.98
Model 4 38.61 4.2 90.385 6.61 200 N 200/118.2 = 1.69
Ultimate masticatory force is the force that results in ultimate stress of 100 MPa in adjacent cortical bone.
cortical plate, with a thinner cortical plate experiencing nearly

double the stress compared to a thicker one [26]. In our study also,
as the thickness of cortical plate decreased, the stresses increased
from 9.7 MPa in Model 1 with 2 mm cortical bone to 38.61 MPa
in Model 4 which had only1 mm of crestal cortical bone.
4. Conclusions
Maximum stress was found to be in the marginal bone at the

implant bone contact area for cortical bone and around the apex
for cancellous bone. Loss of cortical bone at the crest lead to stres-
ses along cancellous bone- implant interface. In our study stress
was distributed over a wider area in case of cancellous bone as
compared to cortical bone. Implant bone assemblies may not sur-
vive for long clinically once bone loss exceeds 25% of implant
length. Though utmost care was taken to fully replicate the implant
bone assembly, there are certain limitations of our study. First of
all, the assumptions made in any FEA analysis can be considered
as its limitations, as many a times some of the assumptions over
Fig. 5. Stress values for cortical bone.
simplify reality. The second limitation is the consideration of only
horizontal bone resorption models and the non-inclusion of verti-
cal bone defects. Those models are being addressed in a separate
study. Investigations on more complex bone defects need to be
conducted to analyse clinical situations of a wider variety.
CRediT authorship contribution statement
Shipra Gupta: Conceptualization, Methodology, Software,

Writing - original draft. Parveen Goyal: Software, Formal analysis,
Visualization. Ashish Jain: Visualization. Priyanka Chopra:
Supervision.
Declaration of Competing Interest
The authors declare that they have no known competing finan-

cial interests or personal relationships that could have appeared
Fig. 6. Stress values for cancellous bone. to influence the work reported in this paper.
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Contents lists available at ScienceDirect

Materials Today: Proceedings

Effect of peri-implantitis associated horizontal bone loss on stress

1. Introduction An implant is considered successful if there is only 1.5–1.8 mm

etiological factors and ensuing inflammation, thereby setting up a

Young’s Modulus Density Poisson’s ratio Tensile strength

cortical plate, with a thinner cortical plate experiencing nearly

Maximum stress was found to be in the marginal bone at the

CRediT authorship contribution statement

Shipra Gupta: Conceptualization, Methodology, Software,

Declaration of Competing Interest

The authors declare that they have no known competing finan-

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