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Biomedical Engineering: Applications, Basis and Communications, Vol. 27, No. 3 (2015) 1550037 (13 pages)
DOI: 10.4015/S1016237215500374
1 1
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6 A SIMPLE AND EFFICIENT METHODOLOGY TO 6
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IMPROVE DESIGN PROPOSALS OF DENTAL
8 8
9 IMPLANTS. A DESIGN CASE STUDY 9
10 10
11 11
12 G. Uzc
ategui*,†, E. D
avila* and M. Cerrolaza†,‡ 12
*National Institute of Bioengineering
13 13
14 Central University of Venezuela, Caracas, Venezuala 14
15 † 15
Oral Surgery Department, Faculty of Dentistry
16 Central University of Venezuela, Caracas, Venezuala 16
AQ: 17 ‡
International Center for Numerical Methods in Engineering (CIMNE) 17
Please
18 indicate the
Polytechnic University of Catalonia, Spain 18
19
corresponding author. 19
20 20
21 21
22 22
ABSTRACT
23 Objective: To propose a methodology based on virtual simulation to assist in the design proposals of dental implants.
23
24 Methods: The ¯nite element method (FEM) was used to analyze the biomechanical dental implant system behavior, 24
25 determining von Mises stress distribution induced by functional loads, varying parameter as load direction and geo- 25
metric characteristic of the implant (taper, length, abutment angulation, thread pitch and width pitch). A ¯nal design
26 26
was obtained by considering the parameters that showed improved performance. The estimated lifetime of the ¯nal
27 design was calculated by reproducing in a virtual way the experimental fatigue test required by the ISO:14801 27
28 standards. Results: For all the studied cases, the maximum stresses were obtained in the connecting screw under 28
29 oblique loads (OLs). The estimated lifetime for this critical part is at least 5
106 cycles, which meets the requirement 29
of the ISO:14801. In bone tissue, the largest stresses were concentrated in cortical bone, in the zone surrounding the
30 implant, in good agreement with previous reports. Conclusions: A dental implant design was obtained and validated 30
31 through a simple and e±cient methodology based on the application of numerical methods and computer simulations. 31
32 32
33 Keywords: Design validation; Assessing methodology; Dental implant; Finite elements. 33
34 34
35 35
36 36
INTRODUCTION cause bone microfractures (see Ref. 2). Therefore, a key to
37 37
the success or failure of implant treatment is the way in
38 Since Branemark (considered as the \father of modern 38
dental implantology") published its ¯ndings in 1977 which stresses are transferred to bone. Accordingly, the
39 39
after 10 years of studying the osseointegration process, implant design is then a key aspect in the transfer of loads
40 40
dental implants have been increasingly used to replace to the supporting bone.3,4 The shape of the dental implant
41 41
missing teeth. This is because of the increased life ex- helps to determine the initial or primary stability and the
42 42
43 pectancy and because dental implants provide a con- available surface area to transmit forces.5 43
44 servative alternative for comfort and aesthetics. 1 Because experimental research on living beings faces 44
45 Preservation of bone surrounding implants is a re- ethical problems inherent to tissue handling and compli- 45
46 quirement for the longevity of implant treatment. Despite cations related to the particularity of each case, computer 46
47 the high success rates reported in the literature, bone simulations have been used for design of prostheses and 47
48 resorption is often a problem faced by these treatments. biomedical devices. Computer simulations allow both 48
49 The hypothesis to explain the loss of bone support is as- specialists and designers to make clear tests and obtain 49
50 sociated with the accumulation of vascularization objective evidence of biological systems, giving useful 50
51 microtraumas that a®ect bone nutrition and stresses that answers to decision-making and helping to predict the 51
52 52

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G. Uzc
avila & M. Cerrolaza

1 behavior of systems with great accuracy. Numerical and 1

2 computational models are developed from mathematical 2
3 equations that incorporate geometric and physical char- 3
4 acteristics. They are advantageously used in problems 4
5 with complex geometries that are di±cult to study with 5
6 other models. The ¯nite element method (FEM) has been 6
7 used in dental implantology for over 20 years, being able 7
8 to accurately simulate a variety of clinical situations by 8
9 in°uencing the improvement of implant practice. 9
10 Baggi et al.6 analyze the in°uence of diameter and 10
11 length variations of ¯ve commercial implants on the risk 11
12 of bone resorption. Tawil et al.7 investigated the e®ect of 12
13 implant diameters on the stress distribution in bone. 13
14 Guan et al.8 reported that implant length has more in- Fig. 1 Image of assembly including implant, prosthetic abutment, 14
15 °uence on trabecular bone, while implant diameter tends screw, crown, cortical and trabecular bone. 15
16 to have more in°uence on the stress distribution at cor- 16
17 tical bone level. Chou et al.9 study cases of implants The mandibular bone segment was constructed with 17
18 placed at di®erent depths in the mandibular bone, oblique a 2 mm layer of cortical bone surrounding B/2-type 18
19 loads (OLs) applied directly on the abutment, ¯nding trabecular bone according to the Lekholm and Zarb13 19
20 higher levels of stress in short implants placed shallow. Ao classi¯cation. 20
21 et al.10 used numerical methods to assess variations in 21
22 threaded cylindrical implants. Lee et al.11 also studied the 22
23 e®ect of some implant threads variations, ¯nding in all 23
24 cases that the largest stresses tend to concentrate on the
Initial implant con¯guration 24
25 ¯rst thread of the implant. Saab et al.4 and Danza et al.2 The implant geometry was initially designed as a slightly 25
26 simulated dental implants behavior with angled abut- conical body to resemble a tooth root (4.2 mm at the im- 26
27 ments. Shen et al.12 studied the in°uence of variations in plant neck and 3 mm at the apex), 13 mm long and 27
28 the implant neck on the stress distribution in bone. threaded surface. Features and speci¯c properties of the 28
29 Most of the research in the area use commercial designs surface were not included in the analysis because the 29
30 and compare the in°uence of one or two parameters on the model assumes complete osseointegration. The thread 30
31 biomechanical behavior of dental implants, but there is no pitch was created of 1 mm and thread width of 0.365 mm 31
32 further reference to the procedure for designing and val- (within the recommended ranges10). The thread was 32
33 idating the design of these devices, by simultaneously created symmetrical and rounded ends as recommended 33
34 considering several characteristic and factors that have by Hansson and Werke.14 The implant neck was designed 34
35 high impact in the design. The methodology proposed with a narrow connection or switch platform, considering 35
36 here combines the ¯nite element analysis (FEA) of the some results already available.15–17 These authors report 36
37 in°uence of several geometric characteristics and load that implant systems with this particular con¯guration 37
38 variables acting on a dental implant (load direction, lessen the vertical bone loss around implants. 38
39 abutment angulation, taper of the implant, implant The implant model was created so that it could be 39
40 length, thread pitch and pitch width) together with the possible to change some parameters (such as implant 40
41 virtual simulation of the e®ect of dynamic loading on the length, taper, thread pitch or thread width), keeping 41
42 implant, following the ISO:14801 standards. constant the rest of the geometry and contacts in other 42
43 parts of the system (prosthetic abutment, screw, cortical 43
44 and trabecular bone). 44
45 Internal hex implant-abutment connection was used 45
46 MATERIALS AND METHODS as shown in Fig. 2, considering its better anti-rotational 46
47 mechanism5 and its tendency to a better distribution of 47
Computer Assisted Dental Implant
48 the load at the implant axis compared to the external 48
49 Design hex connections (see for instance Refs. 18 and 19). The 49
50 A three-dimensional mandible section with an implant implant system tends to be more stable and less prone to 50
51 system was modeled using computer assisted design tool loosening of the screw or fracture,20 partially because of 51
52 Autodesk Inventorr (Fig. 1). the lower lever arm in internal hex connections. 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

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10 Fig. 2 Internal hex implant-abutment connection. 10
11 11
12 (A) (B) 12
The dental implant was considered osseointegrated
13 Fig. 3 Cases considered in the loading simulations. (A) axial load 13
and the implant-abutment interface was considered ¯xed.
14 (AL). (B) oblique load (OL). 14
The implant was placed slightly above the cortical bone
15 15
(see Fig. 1), very close to the bone crest, following the
16 16
suggestion of Rismanchian et al.21 and Le
on et al.22 The
17 17
mandible segment was considered ¯xed on both sides of
18 18
the block (faces perpendicular to the Z-direction of
19 19
Fig. 1). The mechanical properties of the materials used in
20 20
the model are collected in Table 1. All materials used were
21 21
considered isotropic, homogeneous and linearly elastic.
22 22
23 23
24 24
25 Functional loading and FE discretizations 25
Fig. 4 Prosthetic abutments: straight, angled at 15 and 25 .
26 The FEM was used to evaluate the behavior of the 26
27 dental implant system with the original con¯guration 27
28 under static loads, comparing the stress distribution and until the magnitude of the calculated stress at a given 28
29 considering: point becomes almost independent of the number and 29
30 size of the structural elements. Table 2 indicates the 30
31 — Two di®erent force directions, axial and oblique number of elements and nodes used for each FE-mesh of 31
32 loading (Fig. 3). the three abutments analyzed. 32
33 — Three di®erent abutment angulations, straight, an- After examining the stresses in each model compo- 33
34 gled at 15 and 25 (Fig. 4). nents and its variations and after comparison with each 34
35 material's yield point, a proposed design for the dental 35
The straight abutment was used as the initial con¯gura- implant was de¯ned by considering the parameters that
36 36
tion of the implant. Then, speci¯c geometric character- led to the best mechanical response.
37 37
istics were varied individually. These characteristics were
38 38
taper, length, thread pitch and thread width.
39 39
40
A FEM mesh of 10-noded tetrahedral ¯nite elements Virtual Model for the Fatigue Study 40
was used, combined with an h-adaptive re¯nement
41 A study on mechanical fatigue was carried out by con- 41
technique. This technique increases the number of ele-
42 sidering that cyclic loading may lead to device failure, 42
ments at zones having the greatest stress concentration,
43 even reaching maximum stress values that are below the 43
44 Table 1. Material Properties used in the Model.
44
45 Table 2. Number of Elements and Nodes used for the Model. 45
Young's Yield AL Indicates Cases with Axial Loads and OL Cases with
46 Oblique Loads.
46
Modulus Poisson Stress
47 Material (MPa) Ratio (MPa )
47
48 Nodes Elements 48
Titanium (Ti-6Al-4V, 110,000 0.35 880
49 Dental Implant AL OL AL OL 49
Grade 5)
50 Cortical bone 15,000 0.3 130 Straight abutment 279,645 223,901 188,574 147,787 50
51 Trabecular bone 1,500 0.3 38 Angled abutment 15 343,772 266,249 229,344 174,265 51
Ceramic crown 68,900 0.28 400 Angled abutment 25 181,937 181,937 114,689 114,689
52 52

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ategui, E. D

G. Uzc
avila & M. Cerrolaza

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10 Fig. 6 Soderberg criterion for the determination of the safety 10
factor N. Here
a is the alternating stress, Se is the fatigue strength of
11 the material,
m is the mean stress and Sy is the yield stress. 11
12 (A) (B) 12
13 13
Fig. 5 Fatigue test setup. (A) Experimental setup as indicated by conservative method used to establish the safety limit
14 ISO:14801 (2007) standard. (B) Three dimensional model used for 14
15 simulating fatigue tests. for a mechanical component, considering both fatigue 15
16 and yield stresses as shown in Fig. 6. It is usually 16
17 employed in ductile materials and to analyze the me- 17
ultimate strength of the material and even below its chanic parts under cyclic stresses with a positive mean
18 elastic limit. A fatigue study was simulated in the soft- 18
19 value. The main advantage of Soderberg's criterion is 19
ware ANSYS Workbenchr after exporting the implant that it o®ers a direct protection against early yield
20 system geometry, which was virtually built following the 20
21 during a loading cycle. In our particular case, it is 21
3D assembly enforced by the ISO:14801 code.23 mandatory that the implant system does not exceed
22 Figure 5 shows the dental implant installation on a 22
23 neither the fatigue nor the yield limit, otherwise the 23
rigid clamping device according to the ISO standard. prosthetic treatment will fail (see Ref. 25). The main
24 The Young's modulus of this anchoring base must ex- 24
25 idea behind this is to consider a straight line determined 25
ceed 3 GPa, and should clamp the implant at a distance by the fatigue strength and the yield tensile strength of
26 of 3.0 mm  0:1 mm from the implant neck considering 26
27 the material on a plot of the alternating stress versus the 27
that the marginal bone level can move apically following mean stress (Fig. 6).
28 implantation to a relatively steady level. The clamping 28
29 device has a mounting angle of 30  1 relative to the 29
30 loading pinion. The simulation was performed with a 30
31 14 Hz one-way loading frequency in order to verify that 31
RESULTS
32 the components of the ¯nal design ensure a useful life 32
33 After the numerical analyses, stresses distribution were 33
beyond 5
106 cycles. The imposed load varies sinu-
34 obtained within the bone and each part of the implant 34
soidally as required by the ISO standards.
35 system, for all di®erent material, geometrical con¯g- 35
In order to evaluate the SN fatigue curve of the pro-
36 urations and loading types considered. This research was 36
posed implant system, we used the W€ohler's reference
37 addressed to the analysis of the interface bone-implant, 37
curve for the titanium alloy (Ti-6Al-4V), establishing the
38 where the implant is made of titanium, which exhibits 38
material's fatigue properties. The stress versus cycles di-
39 an elastic behavior and then can be characterized using 39
agram is important to gain knowledge on the response of
40 the Von Mises criterion. As well, the study reproduces 40
the proposed device under typical physiological loads.
41 compressive loads simulating masticatory forces, process 41
This diagram allows the analyst to estimate the useful life
42 in which bone also behaves in an elastic way and exhibits 42
of the implant system under clinical conditions. Fatigue
43 high strength. 43
simulations of the ¯nal design were performed using the
44 same protocol used by Han,24 who designed a dental im- 44
45 plant and tested it according to ISO:14801 standard,23 45
46 both in computational and experimental ways. 46
47 Prosthetic Abutment Inclination 47
48 Figure 7 displays maximum stress values for each of the 48
49 parts composing the implant model, for each of the 49
50 Safety factor abutments and load types considered. 50
51 The well-known Soderberg's criterion was used to de- Maximum stress values were obtained for the screws 51
52 termine the reliability of the proposed model. It is a and abutments in the case with straight abutment 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

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17 Fig. 7 Comparison of stress concentration within di®erent parts of the model, for all cases studied. 17
18 18
19 19
under OL and in the case of the 25 -angled prosthetic part and under the screw head, where the geometry
20 20
abutment under oblique loading (Figs. 7 and 8). exhibits lower diameters.
21 21
For each type of prosthetic abutment, all components Within the bone, largest stresses occurred on the
22 22
(implant body, abutment, union screw, cortical and cortical in the vicinity of the implant. Large stresses in
23 23
trabecular bone) have larger stresses when subjected to the cortical and trabecular bone were observed for the
24 24
OL. For implants under AL, the largest Von Mises case of a straight abutment under oblique loading. In all
25 25
stresses were found at implant neck in the contact zone cases, stresses in the trabecular bone were located at the
26 26
with the abutment. For implants under OL stress con- uppermost part surrounding the implant neck (Fig. 9)
27 27
centrations were found not only at the upper boundary and spanning a wider area than for the cortical bone.
28 28
of the implant but also at the internal hexagon area and
29 29
the outer zone of the ¯rst threads. For all cases studied,
30 30
the connecting screw showed larger stress concentrations Implant Conicity
31 31
than at the implant, standing out stresses at the upper Figure 10 shows the con¯gurations of di®erent conic
32 32
33 implants, obtained by changing the diameter at the 33
34 apex. 34
35 Figure 11 displays maximum stress values for each 35
36 case. The best overall performance was retrieved for the 36
37 implant with 3.3 mm at the apex. 37
38 Largest Von Mises stresses were found for the ex- 38
39 treme cases (4 mm and 3 mm at the apex) under OL. In 39
40 all cases, the screw concentrated larger stresses than the 40
41 implant. Figure 12 shows maximum stress values for the 41
42 most cylindrical implant placed at the implant neck and 42
43 on the ¯rst threads. 43
44 44
45 45
46 Implant Length 46
47 Although a larger implant provides more stability right 47
48 after being placed, due to their large contact area with 48
49 the bone, their implantation is not always possible due 49
50 to biological and anatomical conditions. Some authors5 50
51 Fig. 8 Zones with high stress concentration (marked with arrows) for propose the use of short implants, reporting successful 51
52 the 25 -angled abutment under axial loading. cases and clinical statistics and based on their easier 52

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ategui, E. D

G. Uzc
avila & M. Cerrolaza

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Fig. 9 Stress distribution and mesh for the trabecular bone, for the case of straight abutment under OL.
20 20
21 21
22 installation (requires less work and less bone wear). 22
23 However, there is a controversy among success/failure 23
24 rates reported in the literature and concerning the bio- 24
25 mechanical behavior of short implants. Therefore, we 25
26 decided to study the mechanical behavior of implants 26
27 with several implant lengths (Fig. 13) and the e®ect of 27
28 this length on the stress distribution within both im- 28
29 plant and bone. 29
30 Figure 14 shows the maximum stress values for each 30
31 case. 31
32 The best behavior was obtained for the 13 mm-length 32
33 implant under AL, while the largest stresses were 33
34 Fig. 10 Di®erent diameters at the apex of the implant used to vary observed for the shortest implant (8 mm) under AL, as 34
35 the conicity of the implant. depicted in Fig. 14. Figure 15 shows the shortest implant 35
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52 Fig. 11 Comparison of stress concentrations in di®erent parts of the model for di®erent grades of conicity. 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

1 tested (8 mm) and the resulting stress distribution 1

2 for the cortical bone under AL, with implant placed in 2
3 position. 3
4 4
5 5
6 Thread Pitch 6
7 It is a well-accepted opinion that the best clinical results 7
8 8
and biomechanical behavior are achieved with a threa-
9 ded implant. The main reason is the increase of implant– 9
10 10
bone contact surface, leading to a better ¯xation or
11 initial stability and contributing to the mechanical 11
12 12
stimulus needed to keep the bone level, as reported by
13 several authors.14,25–27 After a survey of recent pub- 13
14 lications and considering that implant thread pitch has a 14
15 15
strong impact on stress distribution (see Refs. 10
16 and 28), we considered four di®erent implant versions 16
Fig. 12 Dental implant with a 4 mm apex under OL.
17 17
with four di®erent thread pitchs (see Fig. 16).
18 Figure 17 shows a comparative plot with stress con- 18
19 19
centrations for implants with di®erent thread pitch.
20 The best performance was obtained with the smallest 20
21 21
pitch thread (1 mm) under axial load (AL), while the
22 case having the largest stresses was the implant with 22
23 23
2 mm pitch thread under OL, as shown in Fig. 18.
24 24
Regarding the stress concentrations in the bone, the
25 most critical sites were found in the cortical bone for all 25
26 26
cases, very close to the ¯rst threads of the implant.
27 27
28 28
29 Thread Width 29
30 30
31 The study of Ao et al.10 regarding the optimal thread de- 31
32 sign recommends implants with a thread width between 32
33 0.19 and 0.42 mm. Then, four models were built within the 33
Fig. 13 Di®erent implant lenghts considered in the simulations. range between 0.20 and 0.43 mm, as displayed in Fig. 19.
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52 Fig. 14 Comparison of stress concentrations in di®erent parts of the model for each di®erent implant lengths. 52

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ategui, E. D

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avila & M. Cerrolaza

1 Figure 20 shows maximum stresses for each case. 1

2 The best behavior was obtained for a 0.365 mm 2
3 thread width under AL, followed by the case of 0.43 mm 3
4 thread width. Implants with small thread width led to 4
5 slightly greater stresses at the walls of the implant body 5
6 and small stresses at the outer surface of the thread (see 6
7 Fig. 21). 7
8 In the bone, the largest stresses were obtained in the 8
9 implant with the largest thread width (0.43 mm) under 9
10 OL. Stresses in the cortical and trabecular bone were 10
11 very similar, both values being three times larger than 11
12 for the smallest pitch width considered (0.20 mm). 12
13 13
14 14
(A) (B)
15 Proposed Design 15
16 Fig. 15 (A) Model assembly for an implant with 8 mm length. (B) 16
Stress distribution for the cortical bone subjected to AL. The ¯nal proposed design was obtained after considering
17 17
the e®ect of several geometric con¯gurations and by
18 18
using the parameters that led to the best mechanic be-
19 19
havior. The proposed design is depicted in Fig. 22.
20 20
Figure 23 shows the stress distribution for the pro-
21 21
posed design of the dental implant.
22 22
23 23
24 24
25 Fatigue Analysis 25
26 Following the methodology proposed by Han24 based on 26
27 ISO:14801 code,23 results were obtained according to 27
28 the application of unidirectional cyclic loading pattern 28
29 of values 150, 300, 400 and 500 N at a frequency of 29
30 14 Hz. 30
31 For loads greater or equal to 500 N, the device pre- 31
32 sented fracture failure. For loads lower or equal than 32
33 200 N the implant should have a useful life of more than 33
Fig. 16 Four di®erent thread pitchs used in the simulations.
34 5
106 cycles (minimum required by the ISO:14801 34
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52 Fig. 17 Stress concentrations for implants with di®erent thread pitch. 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

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15 Fig. 18 Results for dental implant system with 2 mm pitch thread under 200 N axial load.
15
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18 ¯rst threads. These results agree with those clinically 18
19 reported elsewhere.29 19
20 Figure 25 shows a diagram of maximum stresses as a 20
21 function of the number of load cycles, used to estimate 21
22 the implant useful life. Based on the plot of Fig. 25 and 22
23 knowing that the maximum stress at the union screw is 23
24 335.85 MPa (under OL), we can assure that the esti- 24
25 mated useful life for this critical part is at least 5
106 25
26 cycles. This time period corresponds to 5 years assuming 26
27 that the person eats three times per day and chews 27
28 during 15 min with a chewing frequency of 1 Hz (60 28
29 cycles in 1 min) according to the ISO:14801 standard. 29
Fig. 19 Variations in the thread width.
30 30
31 31
32 norm). According to the conditions and restrictions 32
imposed on the system, simulations indicate that the
Soderberg's criterion for the implant system
33 33
34 ¯rst elements in risk of failure are the union screw The safety factor is the ratio of the calculated maximum 34
35 (Fig. 24) and the implant itself at the height of the capacity of a system and the actual requirements 35
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52 Fig. 20 Von Mises stresses for each case of thread width of the model. 52

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avila & M. Cerrolaza

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Fig. 21 Stress distribution for implants under OL. (A) Implant with 0.20 mm thread width showing largest stress concentrations around the
17 implant neck and between threads. (B) Implant with 0.43 mm thread width, largest stress concentrations are located at the outer part of the 17
18 threads. 18
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25 25
26 26
27 27
28 28
Fig. 22 Proposed design for the dental implant.
29 29
30 30
31 31
32 Fig. 24 Critical failure zone of the union screw under a 500 N load. 32
33 (A) Von Mises stress distribution (MPa). (B) Lifespan (in cycles). 33
34 34
35 35
Then, the security factor is obtained as:
36 36

a
m 1 Se Sy
37 SF ¼ þ ¼ !N¼ ¼ 1:52 37
38 Se Sy N Sy
a þ Se
m 38
39 The security factor obtained is satisfactory, indicating 39
40 that the ¯rst component in risk of failure (union screw) 40
41 will bear 1.52 times the mean stress. The work of 41
42 Fig. 23 Maximum stresses for the proposed dental implant system. Kayabasi et al.,30 who calculated the useful life of a 42
43 dental implant, shows a plot of the security factor as a 43
44 to which the system will be subjected. To estimate the function of the torque sustained by the implant. The 44
45 security factor of our ¯nal design, the Soderberg's cri- value of SF ¼ 1:5 is in good agreement with the one 45
46 terion was used, considering an implant fatigue stress obtained in this research. 46
47 (Se ) of 360 MPa and a titanium alloy yield stress (Sy ) of 47
48 880 MPa (see Table 1). The most critical mean stresses 48
49 were calculated taking into consideration the union 49
50
DISCUSSION 50
screw, as follows:
51 In all cases studied and for all model components, larger 51
52
a ¼
m ¼
max =2 ¼ 335:85 MPa=2 ¼ 167:92 stresses were observed under OL, in agreement with the 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

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15 15
16 16
17 Fig. 25 Diagram used to estimate the useful life of the impant. 17
18 18
19 19
20 results of Ding et al.31 These loads must be controlled and (c) when possible, splint several implants through 20
21 with an appropriate design of the prosthetic restoration the dental prosthesis. 21
22 to be placed on top of the implant. The most inclined The ¯nal design has a 1 mm thread pitch which is 22
23 abutment tends to produce high stress concentrations, consistent with the work of Ao et al.10 who recommend 23
24 specially in the screw and in the abutment itself. In the the use of thread pitch greater than 0.44 mm in order to 24
25 same direction, Clelland et al.32 reported also an increase ensure enough space for the vital development of 25
26 of stress magnitude as the abutment angulation increases. osteons. Our results are also in very good agreement 26
27 The proposed implant design is slightly conical with those reported by Kong et al.35 who recommended 27
28 agreeing well with in vivo studies11 and in vitro studies.28 to avoid using thread pitch greater than 1.6 mm. 28
29 These reports show that partly conical implants are re- Regarding the thread width, the best result was 29
30 lated with a greater primary stability in comparison obtained for an intermediate case. Implants with lower 30
31 with cylindrical implants. Wu et al.33 pointed out that thread width led to slightly greater stresses at the walls 31
32 conical implants are more resistant and easier to install of the implant body and lower stresses at the outer 32
33 in bone. However, Lee et al.34 suggest that conical surface of the thread. The widest implant showed largest 33
34 implants should be indicated when both axial and tan- stress at the outer thread zone. According to Hansson 34
35 gential loads do not represent a critical biomechanical and Werke,14 the thread pro¯le a®ects the peak stress 35
36 factor. found in the bone and the ability of the implant to 36
37 Regarding the length, the longest implant showed the withstand loads. Thread width is important because, 37
38 best behavior, which is in good agreement with results just like the thread pitch, it increases the contact surface 38
39 published by Ding et al.31 who concluded that long at the implant-bone interface, thus improving stability. 39
40 implants reduced stresses and deformations at the al- In this sense Misch25 stated that a cylindrical implant 40
41 veolar crest. Regarding this issue, a retrospective clinical with no thread and large diameter has lower contact 41
42 study25 of six years discusses two risk factors that may surface than a threaded implant of lower diameter. 42
43 be related to the high failure rates of short implants: In bone, for all the cases studied herein, the largest 43
44 short implants have a high crown-implant ratio which stress concentrations were found at the cortical part, 44
45 increases the lever arm, moreover they tend to be posi- within the vicinity of the implant. The latter agrees well 45
46 tioned in posterior cases where high occlusal forces are with previous works,2,4,5 where the authors report that 46
47 received and bone density is low. Both length and di- stresses dissipation in the cortical bone is limited to the 47
48 ameter of the implant are usually selected according to area surrounding the implant (at the tip of the thread) 48
49 speci¯c clinical conditions in each patient. However, in due to the high strength of cortical bone when compared 49
50 cases where short implants are required it is recom- to trabecular bone. Misch25 indicates that inside tra- 50
51 mended5: (a) to avoid horizontal and angled forces on becular bone, stress dissipation usually spans a wider 51
52 prosthetic restorations; (b) to place cantilever prosthesis zone than inside cortical bone. 52

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ategui, E. D

G. Uzc
avila & M. Cerrolaza

1 The proposed implant system showed the best me- indebted to the International Center for Numerical 1
2 chanic behavior also ful¯lling the requirements estab- Methods in Engineering (CIMNE) of the Polytechnic 2
3 lished in ISO:14801. In a simulated fatigue test, it University of Catalonia. 3
4 reached a useful life beyond 5
106 load cycles. 4
5 According to the fatigue study, the connecting screw 5
6 showed the largest stress concentration at a point under 6
7 the screw head, representing the ¯rst zone prone to fail. REFERENCES 7
8 About this topic Pessoa et al.36 also report that the 1. Schenk R, Buster D, Osseointegration: A reality, Peri- 8
9 screw union is a critically important part. It is known odontology 17:22, 1998. 9
10 that the risk of failure is reduced by controlling forces 2. Danza M, Palmieri A, Farinella F, Brunelli G, Carinci F, 10
Girardi A, Spinelli G, Three dimensional ¯nite element
11 acting on the implant,25 something that can be achieved 11
analysis to detect stress distribution in spiral implants
12 considering the position of the restoration within the and surrounding bone, Dental Res 6:59, 2009. 12
13 arc, eliminating load moments, reducing occlusal con- 3. Cehreli M, Sahin S, Akca K, Role of mechanical envi- 13
14 tacts of the prosthesis, controlling parafunctional habits ronment and implant design on bone tissue di®erentia- 14
15 and increasing the surface available to stand up loads. tion: Current knowledge and future contexts, J Dentistry 15
32:123, 2004.
16 16
4. Saab X, Griggs J, Powers J, Engelmeier R, E®ect of
17 abutment angulation on the strain on the bone around an 17
18 implant in the anterior maxilla, Prosthetic Dent 97:85, 18
19
CONCLUSIONS 2007. 19
20 An e±cient and simple methodology for the design and 5. Siegele D, Soltesz U, Numerical investigations of the in- 20
21 validation of a dental implant system was proposed and °uence of implant shape on stress distribution in the jaw 21
bone, Oral Maxillofac Implant 4:333, 2004.
22 discussed. The e®ects of some geometric parameters on 22
6. Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G,
23 the biomechanical behavior of the implant were con- The in°uence of implant diameter and length on stress 23
24 sidered to estimate the implant lifespan based on a vir- distribution of osseointegrated implants related to crestal 24
25 tual fatigue test. Realistic dimensions, material bone geometry: A three dimensional ¯nite element anal- 25
26 properties and loading forces were considered and results ysis, Prosthetic Dent 100:422, 2008. 26
7. Tawil G, Aboujaoude N, Younan R, In°uence of pros-
27 were compared and validated with previous works. 27
thetic parameters on survival and complication rates of
28 For the ¯nal implant design, within the limitations of short implants, Oral Maxillofac Implant 21:275, 2006. 28
29 this study, the considerations assumed in the model and 8. Guan H, van Staden R, Loo Y, Johnson N, Ivanovski S, 29
30 under the loads studied the values of the stress con- Meredith N, In°uence of bone and dental implant para- 30
31 centrations did not reach the elastic limit, which is rel- meters on stress distribution in the mandible, Oral Max- 31
32 evant to avoid osseointegration problems or possible illofac Implant 24:866, 2010. 32
9. Chou H, Müftü S, Bozkaya D, Combined e®ects of im-
33 fracture of parts of the implant system. Through com- 33
plant insertion depth and alveolar bone quality on peri-
34 puter simulations we estimated that the dental implant implant bone strain induced by a wide-diameter, short 34
35 would have a lifespan that complies with ISO:14801 implant and a narrow-diameter, long implant, Prosthetic 35
36 standard.23 Dent 104:293, 2010. 36
37 A dental implant treatment and prognosis strongly 10. Ao J, Li T, Liu Y, Ding Y, Wu G, Hu K, Kong L, Op- 37
timal design of thread height and width on an immedi-
38 depend on the design and structural properties of the 38
ately loaded cylinder implant, Comput Biol Med 40:681,
39 bone/implant system. Numerical methods such as ¯nite 2010. 39
40 elements (or boundary elements) are very useful to 11. Lee Ch, Lin S, Kang M, Wu S, Fu P, E®ects of implant 40
41 evaluate displacements and stress ¯elds in non-trivial threads on the contact area and stress distribution of 41
42 geometries. Particularly in biomechanics, this evalua- marginal bone, Dental Sci 5:156, 2010. 42
43 tion becomes of the most concern because it must take 12. Shen W, Chen C, Hsu M, In°uence of implant collar de- 43
sign on stress and strain distribution in the crestal com-
44 into account the bone tissue around the implant in order 44
pact bone: A 3D FEM analysis, Oral Maxillofac Implant
45 to avoid overload and necrosis. 25:901, 2010. 45
46 13. Lekholm U, Zarb GA, Patient selection and preparation, 46
47 in Branemark PI, Zarb GA, Albrektsson T (eds.) Tissue- 47
48 integrated Prosthesis: Osseointegration in Clinical Den- 48
49
ACKNOWLEDGMENTS tistry, Quintessence, Chicago, 1985.
49
14. Hansson S, Werke M, The implant thread as a retention
50 The authors acknowledge the partial support provided element in cortical bone: The e®ect of thread size and 50
51 by the European Research Council through the thread pro¯le: A ¯nite element study, Biomechanics 51
52 grant FP7-PEOPLE-2011-CIG-303861. Also, they are 36:1247, 2003. 52

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A Simple and E±cient Methodology to Improve Design Proposals of Dental Implants

1 15. Lazarra R, Porter S, Platform switching: A new concept 26. Norton M, Marginal bone levels at single tooth implants 1
2 in implant dentistry for controlling postrestorative crestal with a conical ¯xture design. The in°uence of surface 2
bone levels, Periodontics Rest Dent 26:9, 2006. macro- and microstructure, Clin Oral Imp Res 9:91, 1998.
3 3
16. Canullo L, Rasperini G, Preservation of peri-implant soft 27. Palmer R, Palmer P, Smith B, A 5-year prospective study
4 and hard tissues using platform switching of implants of Astra single tooth implants, Clin Oral Imp Res 11:179, 4
5 placed in immediate extraction sockets: A proof-of-con- 2000. 5
6 cept study with 12- to 36-month follow-up, Oral Max- 28. Elias C, Rocha F, Nascimento A, Coelho P, In°uence of 6
7 illofac Implant 22:995, 2007. implant shape, surface morphology, surgical technique 7
8 17. Momen A, Ibrahim H, Atieh A, Platform switching for and bone quality on the primary stability of dental 8
marginal bone preservation around dental implants: A implants, Mech Behav Biomed Mater 16:169, 2012.
9 9
systematic review and meta-analysis, Periodontology on de fragmento de tornillo
29. Iglesia M, Arellano A, Extracci

10 81:1350, 2010. de fracturado intra-implante. A prop
osito de un caso, Rev 10
11 18. Maeda Y, Satoh T, Sogo M, In vitro di®erences of stress Esp Odontostomatolog
{a de Implantes 9:201, 2001. 11
12 concentrations for internal and external hex implant– 30. Kayabaşı O, Yüzbasıoğlu E, Erzincanl F, Static, dynamic 12
13 aditament connections: A short communication, Oral and fatigue behaviors of dental implant using ¯nite ele- 13
Rehabil 33:75, 2006. ment method, Adv Eng Soft 37:649, 2006.
14 14
19. Bernardes S, Amaral C, Fernandes A, Simamoto P, 31. Ding X, Liao SH, Zhu XH, Zhang XH, Zhang, L, E®ect of
15 Domingues F, Photoelastic analysis of stress patterns diameter and length on stress distribution of the alveolar 15
16 from di®erent implant-abutment interfaces, Oral Max- crest around immediate loading implants, Clin Imp Dent 16
17 illofac Implant 24:781, 2009. & Relat Res 11:279, 2009. 17
18 20. Pellizzer E, Tonella B, Ferraco R, Falcon-Antenucci R, de 32. Clelland NL, Lee JK, Bimbenet OC, Brantley WA, A 18
19 Carvalho P, Goiato M, Photoelastic analysis of cemented three-dimensional ¯nite element stress analysis of angled 19
or screwed implant-supported prostheses with di®erent abutments for an implant placed in the anterior maxilla,
20 20
prosthetic connections, Oral Implant 16:1, 2010. Prosthodontics 4:95, 1995.
21 21. Rismanchian M, Askari N, Sha¯ei S, The e®ect of place- 33. Wu S, Lee C, Fu P, Lin S, The e®ects of °ute shape and 21
22 ment depth of platform-switched implants on periimplant thread pro¯le on the insertion torque and primary sta- 22
23 cortical bone stress: A 3-dimensional ¯nite element anal- bility of dental implants, Med Eng Phys 34:797, 2012. 23
24 ysis, J Implant Dent 22:165, 2013. 34. Lee J, Frias V, Lee K, Wright R, E®ect of implant size and 24
22. Le
on J, Carrascosa A, Rodríguez X, Ruiz-Magaz V, shape on implant success rates: A literature review,
25 25
Pascual A, Nart J, Finite element analysis relative to the Prosthetic Dent 94:377, 2005.
26 crestal position of a 3.0-mm-diameter implant, J Peri- 35. Kong L, Zhao Y, Hu K, Li D, Zhou H, Wu Z, Liu B, 26
27 odontics Restorative Dent 34:381, 2014. Selection of the implant thread pitch for optimal bio- 27
28 23. ISO 14801, Dentistry-Implants Dynamic fatigue test for mechanical properties: A three-dimensional ¯nite element 28
29 endosseous dental implants, USA, 2007. analysis, Adv Eng Soft 40:474, 2009. 29
30 24. Han HS, Design of new root-form endosseous dental im- 36. Pessoa R, Muraru L, Marcantonio E, Vaz L, Vander 30
plant and evaluation of fatigue strength using ¯nite ele- Sloten J, Duyck J, Jaecques S, In°uence of implant con-
31 31
ment analysis, Unpublished Doctoral Thesis, University nection type on the biomechanical environment of im-
32 of Iowa, USA, 2009. mediately placed implants–CT-based nonlinear, three- 32
33 25. Misch C, Dental Prostheses on Implants (in Spanish), Ed. dimensional Finite Element analysis, Clin Implant Dent 33
34 Mosby, Madrid, 2007. Rel Res 12:219, 2010. 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
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