UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4168
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Braz Dent Sci 2024 Apr/June;27 (2): e4168
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Stress distribution in peri-implant bone, implants, and prostheses:
3D-FEA of marginal bone loss and prosthetic design
Distribuição de estresse no osso peri-implantar, implantes e próteses: análise 3D-FEA de perda óssea marginal e design
protético
Şehrize Dilara INCI1 , Volkan TURP2 , Firdevs Betul TUNCELLI3
1 - Istanbul University, Faculty of Dentistry, Department of Prosthodontics. Istanbul, Turkey
2 - Istanbul University Faculty of Dentistry, Department of Prosthodontics. Istanbul, Turkey.
3 - Nisantasi University Faculty of Dentistry, Department of Prosthodontics. Istanbul, Turkey.
How to cite: Inci SD, Turp V, Tuncelli FB. Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone
loss and prosthetic design. Braz Dent Sci. 2024;27(2):e4168. https://doi.org/10.4322/bds.2024.e4168
ABSTRACT
Objective: In response to the demand for dental implants, extensive research has been conducted on methods
for transferring load to the surrounding bone. This study aimed to evaluate the stresses on the peripheral bone,
implants, and prostheses under scenarios involving of the following variables: prosthesis designs, vertical bone
heights, load angles, and restorative materials. Material and Methods: Three implants were inserted in the
premolar and molar regions (5-6-7) of the two mandibular models. Model 1 represented 0 mm marginal bone loss
and Model 2 simulated 3 mm bone loss. CAD/CAM-supported materials, hybrid ceramic (HC), resin-nano ceramic
(RNC), lithium disilicate (LiSi), zirconia (Zr), and two prosthesis designs (splinted and non-splinted) were used
for the implant-supported crowns. Forces were applied vertically (90°) to the central fossa and buccal cusps and
obliquely (30°) to the buccal cusps only. The stresses were evaluated using a three-dimensional Finite Element
Analysis. Results: Oblique loading resulted in the highest stress values. Of the four materials, RNC showed the
low stress in the restoration, particularly in the marginal area. The use of different restorative materials did not
affect stress distribution in the surrounding bone. The splinted prostheses generated lower stress magnitude on
the bone, and while more stress on the implants were observed. Conclusion: In terms of the stress distribution
on the peri-implant bone and implants, the use of different restorative materials is not important. Oblique loading
resulted in higher stress values, and the splinted prosthesis design resulted in lower stress.
KEYWORDS
Biomechanics; Dental implant; Finite element analysis; Prosthodontics; Restorative dentistry.
RESUMO
Objetivo: Em resposta à demanda por implantes dentários, extensa pesquisa foi realizada sobre métodos para
transferir carga ao osso circundante. Este estudo buscou avaliar os estresses no osso periférico, implantes e
próteses em cenários que envolvem as seguintes variáveis: designs de próteses, alturas ósseas verticais, ângulos
de carga e materiais restauradores. Material e Métodos: Três implantes foram inseridos nas regiões dos pré-
molares e molares (5-6-7) de dois modelos de mandíbula. O Modelo 1 representou perda óssea marginal de 0
mm e o Modelo 2 simulou perda óssea de 3 mm. Materiais suportados por CAD/CAM, cerâmica híbrida (HC),
cerâmica nano-resina (RNC), dissilicato de lítio (LiSi), zircônia (Zr) e dois designs de próteses (sintetizadas e não-
sintetizadas) foram utilizados para as coroas suportadas por implantes. Forças foram aplicadas verticalmente (90°)
à fossa central e cúspides bucais e obliquamente (30°) apenas às cúspides bucais. Os estresses foram avaliados
usando Análise de Elementos Finitos tridimensional. Resultados: Cargas oblíquas resultaram nos valores mais
altos de estresse. Entre os quatro materiais, RNC mostrou baixo estresse na restauração, especialmente na área
marginal. O uso de diferentes materiais restauradores não afetou a distribuição de estresse no osso circundante.
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Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
INTRODUCTION
In clinical dentistry, implant-supported
prostheses are the first option to consider for
restoring edentulous areas because of their
biocompatibility, predictable long-term results,
and favorable mechanical properties [1].
The entire procedure involves substantial costs
and complexity. Therefore, long-term success
of an implant is crucial for the integrity of the
surrounding bone. Given the structural differences
between natural teeth and implants, one of the
main factors in implant success is how stress is
transferred to the alveolar bone [2]; the lack of
periodontal ligaments around an implant causes
forces to be transferred directly to the bone [3,4].
Excessive loads can cause fatigue failure of an
implant, resulting in damage to the prosthesis
and abutment, and resorption of the peri-implant
bone [5]. Parameters such as the mechanical
properties of restorative materials and implants,
direction of forces, and design of the prosthesis
may affect stress formation and distribution on the
implant and surrounding bone tissues [6].
Three-dimensional (3D) finite element
analysis (FEA) is a practical method that
evaluates the stress distribution in areas of
complex geometry, such as the interface
between an implant and bone [7]. This method
provides consistent results measuring stress,
compression, and displacement in implants
and structures during rehabilitation; therefore,
FEA is a promising noninvasive technique [8].
This approach involves subdividing the intricate
mechanical model into smaller segments,
enabling researchers to anticipate and validate
stress distribution at the potential bone-implant
interface [9].
Computer-aided design/computer-aided
manufacturing (CAD/CAM) enables clinicians
to create monolithic models of various materials
with varying elastomeric properties that can be
applied to implant-supported prostheses. The use
of CAD/CAM technology enables the production
of a diverse range of materials with different
rigidities, from zirconia to resin-matrix ceramics,
thus affording clinicians the opportunity to select
and utilize their preferred materials [7].
There have been a number of studies
conducted to identify materials [7,10-13] and
prosthesis designs [12-17] that can tolerate stress
in implant-supported xed prostheses. However,
the results have shown conflicting results and
to date no optimal solution has been identied.
Despite the abundance of the electronic literature,
a thorough analysis of stress occurrences in
implant-supported prostheses across various
scenarios is lacking. To address this gap, this
study offers an unprecedented and meticulous
evaluation, distinguishing itself from previous
research in the field. This study evaluated the
stress distribution in implants, peripheral bone,
and prostheses by using the 3D FEA method to
model different restorative material types, load
angles, prosthesis designs, and bone heights.
The primary objective is to provide clinicians with
the most effective means of reducing stress placed
on the peri-implant bone, prosthesis, and implants.
MATERIAL AND METHODS
Two models representing the right
mandibular molar bone section with different
amounts of marginal bone loss were created
geometrically using a computer software (VRMesh
Studio; VirtualGrid Inc. Bellevue City, WA, USA).
The specications were 2 mm cortical and 25.067,
58.300, and 35.636-mm thicknesses on the x-, y,
and z-axes, respectively. The two models were
converted to the Standard Tessellation Language
(STL) format to make them eligible for analysis.
Rhinoceros (Version 4.0SR8; McNeel North
America, Seattle, WA, USA) CAD software was
used to model the 3D structures. Three regular
titanium implants (Bone Level CrossFit SLA
Implant; 4.1 × 12 mm, Institute Straumann®
AG, Basel, Switzerland), titanium abutments
(RC Variobase for Crown; Straumann) 4.5 mm in
Próteses sintetizadas geraram menor magnitude de estresse no osso, enquanto mais estresse nos implantes
foi observado. Conclusão: Em termos de distribuição de estresse no osso peri-implantar e implantes, o uso de
diferentes materiais restauradores não é crucial. Cargas oblíquas resultaram em valores mais altos de estresse,
e o design de prótese sintetizada resultou em menor estresse.
PALAVRAS-CHAVE
Biomecânica; Implante dentário; Análise de elementos nitos; Prótese dentária; Odontologia restauradora.
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Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
diameter and 5.5 mm in height, and their inner
screws were scanned with Activity 880 (Smart
Optics Sensortechnik GmbH, Sinterstrasse 8,
D-44795 Bochum, Germany) to analyze stress
on the crown, implant, and peripheral bone.
Computer-generated data from the lower and
upper structural parts of the prosthesis, implant
screws, and bone tissues were harmonized
using Boolean operations. The results for the
cortical and cancellous bone were recorded
separately [18].
The bone structure of the model was xed in
all directions. A static load was applied vertically
(90°) and obliquely (30°). A vertical load was
applied to the central fossa and buccal cusps,
whereas an oblique load was applied only to the
buccal cusps. The vertical load was 500 N and
the oblique load was 250 N [6]. In each direction
of force (vertical and oblique), the total load
was divided such that the force at each point
of application was equal (
e.g.
, a total load of
500 N was divided such that ve loading points
[buccal cusps, central fossa, and three others]
each received 100 N force). The loading points
were determined according to the implant-
supported prosthesis occlusal scheme [5]. One
model simulated 0 mm marginal bone loss
with a splinted crown design, and the second
simulated 3 mm marginal bone loss with a non-
splinted crown design [19]. In both models, the
implants were located in the second premolar,
rst molar, and second molar areas. The three-
dimensional components of the crowns were
modeled as monolithic. The gingiva was ignored
in both models, and a cement layer was generated
between the abutment and crown to mimic
clinical conditions [7,20]. The resin cement
thickness was assumed to be 0.3 mm [20]. Four
different materials were used for the prosthetic
structures: hybrid ceramic (HC), resin-nano
ceramic (RNC), lithium disilicate (LiSi), and
zirconia (Zr). The elastic modulus values and
Poisson’s ratios (
i.e.
, physical property measures)
for the investigated material types and structures
were derived from the literature (Table I).
The mesh was created with 71.302 nodes and
307.522 nite elements for the rst model and
with 62.239 nodes and 297.626 nite elements
for the second model after the (10%) convergence
test for both models [22]. The materials were
considered to be homogeneous, isotropic, and
linearly elastic. Because this study did not evaluate
the torque failure, the contacts were assumed to
be bonded. The implants were assumed to be
100% osseointegrated. Stress distribution in the
peripheral bone was evaluated using Maximum
and Minimum Principal Analyses, and stress
values in implants and prosthetic structures were
evaluated using von Mises analysis.
RESULTS
Figure 1 shows the vertical (A) and oblique
(B) loading conditions for Model 1, and the
vertical (C) and oblique (D) loading conditions
for Model 2.
Figure 2 shows the Maximum and Minimum
Principal stresses on the cancellous and cortical
bones for vertical and oblique force applications
using each of the four materials in the two models.
Figures 3A and 3B show the results of
the von Mises analysis for stresses around the
restorative crowns and implants under different
loading scenarios.
Table II summarizes the findings for the
maximum and minimum principal stresses on
the cortical and cancellous bone and von Mises
stress on the crowns and implants.
Oblique loading resulted in higher stress
values than vertical loading for the implants,
crowns, and cortical and cancellous bones
(Table II). In the cortical bone, the minimum
principal stress values were higher than the
maximum principal stress values, whereas the
opposite was observed in the cancellous bone
(Table II and Figure 2). The maximum and
minimum principal stress values under vertical
loading in Model 1 were higher than those
in Model 2 (Figure 2A). The maximum and
minimum principal stress values under oblique
loading in Model 2 were higher than those in
Model 1 (Figure 2B).
Table I - Mechanical properties of materials tested in the study
Material Elastic modulus
(GPa) Poisson ratio
Resin cement 7.5 [20] 0.25 [20]
Hybrid ceramic 30 [7] 0.23 [7]
Resin-nano ceramic 10.3 [21] 0.3 [22]
Lithium disilicate 63.9 [23] 0.22 [23]
Zirconia 220 [24] 0.33 [24]
Cortical bone 13.7 [19] 0.3 [19]
Spongy bone 1.37 [19] 0.3 [19]
Titanium 110 [10] 0.35 [10]
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Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Figure 1 - Vertical (A) and oblique (B) loading conditions of Model 1, vertical (C) and oblique (D) loading conditions of Model 2.
Figure 2 - Maximum and minimum stress values under oblique (A) and vertical (B) forces in the cancellous and cortical bone in Model 1 and Model 2.
Table II - Maximum and minimum principal stresses for cortical and cancellous bone, and the von Mises stress values recorded for crowns and
implants in the two models
Crown material
HC LiSi RNS Zr
Model 1
Vertical load
(MPa)
Cortical bone 27.06-3.47 26.71-3.57 27.70-3.22 26.37-3.66
Cancellous bone 4.17-1.13 4.14-1.12 4.23-1.16 4.12-1.11
Implants 175.88 172.27 182.30 168.76
Crowns 37.8 52.12 20.6 65.89
Oblique load
(MPa)
Cortical bone 26.33-28.19 26.29-27.89 26.55-28.27 26.43-27.26
Cancellous bone 2.45-2.16 2.45-2.13 2.46-2.36 2.44-2.11
Implants 344.3 341.51 349.34 339.81
Crowns 51.19 55.71 35.07 61.35
Model 2
Vertical load
(MPa)
Cortical bone 25.54-1.59 25.39-1.54 25.79-1.69 25.01-1.5
Cancellous bone 0.93-3.11 0.94-3.01 0.92-3.25 0.94-2.87
Implants 91.83 89.89 94.19 85.75
Crowns 35.49 38.69 25.46 56.70
Oblique load
(MPa)
Cortical bone 62.71-32.59 62.87-34.42 62.56-33.49 63.02-31.78
Cancellous bone 1.91-4.18 1.9-4.01 1.93-4.46 1.87-3.79
Implants 184.44 183.03 185.99 178.77
Crowns 139.68 174.98 80.42 178.61
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Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Under oblique loading, various restorative
materials generated different maximum and
minimum principal stress values in cortical
and cancellous bones. LiSi exhibited the
highest maximum principal stress value in
Model 1 (34.42 MPa), and Zr exhibited the
lowest maximum principal stress value in
Model 2 (1.5 MPa). The highest and lowest
minimum principal stress values (-63.02 MPa and
-25.01 MPa, respectively) were observed with Zr
in Model 2, with the highest being under oblique
loading and the lowest under vertical loading.
The maximum and minimum physiological
stress limits of the cortical bone (173 MPa and
100 MPa, respectively) were not exceeded in
either model under any of the scenarios tested.
When each restorative material was analyzed
individually, the total stress values for the cortical
bone were identical (Table II). Regarding the
cancellous bone, HC under oblique loading in
Model 2 exhibited the highest maximum principal
stress (4.46 MPa), and Zr under vertical loading in
Model 1 exhibited the lowest maximum principal
stress (1.11 MPa). The highest and the lowest
minimum principal stress values (-4.23 MPa and
-0.92 MPa, respectively) were observed with RNS
under vertical loading. The RNS values in Model
1 were higher than those in Model 2.
Under vertical loading, the effects of the
two different prosthesis designs on cortical and
cancellous bones were similar. However, the
splinted prosthesis design under oblique loading
resulted in a more favorable stress distribution
than the non-splinted prosthesis design. In each
scenario, the stress concentration and pattern were
the same. In Model 1 (Figure 4), the maximum
and minimum stresses occur in the distobuccal
region of the cortical bone under vertical loading.
In the cancellous bone, the maximum and
minimum principal stresses were concentrated
in the buccal region of the bone. Under oblique
loading in Model 1, the maximum principal
stresses occurred around the implants. In contrast,
the minimum principal stresses were more widely
spread, but more concentrated in the distobuccal
region of the bone. In Model 2 (Figure 5),
the maximum and minimum stresses were
concentrated in the distal region of the cortical
bone under vertical loading.
In the cancellous bone, the maximum and
minimum principal stresses were concentrated
in the palatal and buccal regions of the bone.
Under oblique loading in Model 2, the maximum
principal stresses were concentrated around the
implants but more concentrated in the palatal
region, and the minimum principal stresses were
concentrated in the distobuccal region of the bone.
Figure 3 - Von Mises stress values observed in restorative crowns (A) and implants (B) under oblique and vertical loading.
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Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Figure 4 - All scenarios that were applied for Model 1 under vertical loading: maximum principal stress in cortical bone (A); minimum principal
stress in cortical bone (B); maximum principal stress in cancellous bone (C); minimum principal stress in cancellous bone (D); von Mises analysis
in implants (E). All scenarios that were applied for Model 1 under oblique loading: maximum principal stress in cortical bone (I); minimum
principal stress in cortical bone (F); maximum principal stress in cancellous bone (G); minimum principal stress in cancellous bone (H); von Mises
analysis in implants (J).
A) B)
C) D)
E) F)
G) H)
I) J)
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Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Figure 5 - All scenarios that were applied for Model 2 under vertical loading: maximum principal stress in cortical bone (A); minimum principal
stress in cortical bone (B); maximum principal stress in cancellous bone (C); minimum principal stress in cancellous bone (D); von Mises analysis
in implants (E). All scenarios that were applied for Model 2 under oblique loading: maximum principal stress in cortical bone (I); minimum
principal stress in cortical bone (F); maximum principal stress in cancellous bone (G); and minimum principal stress in cancellous bone (H); von
Mises stress analysis in implants (J).
A)
C)
E)
G)
I)
B)
D)
F)
H)
J)
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Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
All the restorative materials generated
comparable implant stress values. The highest
von Mises stress values were observed for RNS
under oblique loading in Model 1 (349.34 MPa),
and the lowest values were observed for Zr under
vertical loading in Model 2 (85.75 MPa). Under
vertical loading, stresses were concentrated in the
neck region of the implant and decreased toward
the apex, whereas under oblique loading, stresses
were more widespread through one-third of the
middle portion of the implant (Figures 4 and 5).
The splinted prosthesis design generated more
stress around the implants than the non-splinted
design. In both models, the highest stress values
were concentrated at the buccal tubercles, force
application sites, central fossa, contact areas, and
marginal nishing line (Figure 6).
In Model 1, the stresses that occurred at the
occlusal surface were more widespread than those
observed in Model 2. The highest von Mises values
were recorded for Zr in Model 2 (178.61 MPa)
and the lowest von Mises values were observed
for RNS in Model 1 (20.6 MPa). The splinted
prosthesis design generated favorable stress
values for the restorative crowns.
DISCUSSION
The results of this study indicate that none
of the restorative materials tested have signicant
effects on the peri-implant bone; however, the
load angle and prosthesis design may have a
signicant impact on stress generation. Although
this is a theoretical study that assumes ideal
bonding conditions for each scenario, the
ndings for material mechanics are of scientic
signicance [20].
According to this study and previous
literature, the force applied to a dental implant
primarily loads the neck area and near the
threads of the abutment [7,10,18,23]. This can
be explained by an engineering principle: stresses
at the point of application are greatest when a
load is applied between two materials that have
different moduli of elasticity [24]. Teeth and
cortical bone have similar moduli of elasticity,
whereas titanium implants have a modulus of
elasticity 5 or 10 times greater. Thus, the load
on the tooth does not create much stress at the
crest interface, whereas the load on the implant
may cause signicant stress on the bone even if
it is partially transmitted [5].
To analyze stress on the crown, implant,
and peripheral bone, we used two models for
simulating a 0 mm and a 3 mm marginal bone
loss with different prosthesis designs. Studies
by Manzoor et al. [19] and Kitamura et al. [25]
showed that bone loss of more than 2.6 mm
could lead to biomechanical failure. In our
study, biomechanical failure was not observed
under either of the loading conditions. In Model
2, however, less stress was generated on the
implants, more stress was generated on the
restorative crowns, and equal stress was generated
on the peri-implant bone than in Model 1.
As the oral environment is dynamic, occlusal
forces are applied in multiple directions, resulting
in a leverage effect on the oral bone. As in the
present study, investigations conducted using
FEA should combine different angulated forces to
mimic oral conditions [26]. In line with several
previous studies, the present study demonstrated
that oblique loading causes more significant
stress on cortical and cancellous bone tissue than
vertical loading [6,7,10,12,14].
Cortical bone has a higher elastic modulus
than cancellous bone making it more resistant to
occlusal forces and deformation. Thus, cortical
bone tissue is more resistant to stress than
cancellous bone tissue and forms a stronger
bond with implants [27]. The current study
demonstrated that stresses in peri-implant cortical
bone tissue are higher than those in cancellous
bone and that stresses decrease towards the apex.
Previous FEA investigations have shown that
forces are concentrated in the cortical bone, as
observed in the current study [7,10,14,22,23,28].
It has also been stated that the cortical bone
near the neck of an implant sustains the highest
stress [7,20,29].
The yield strength is the point at which elastic
deformation transitions to plastic deformation.
Titanium implants have a maximum yield
strength of 550 MPa. An implant may fail if the
maximum von Mises value exceeds the yield
strength [30]. None of the von Mises values
recorded in the present study exceeded the
maximum yield strength.
The different restorative materials did not
signicantly affect the loads transferred to the
peri-implant bone (Table II). Khazaei et al. [10]
modeled implant-supported bridges using materials
with four different elastic moduli: polymethyl
methacrylate, full metal, metal-based ceramics,
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Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Figure 6 - Results for the study scenarios in the restorative crowns. All scenarios that were applied under vertical loading: von Mises stress
analysis in Model 1 (A1-occlusal view, A2-gingival view); von Mises stress analysis in Model 2 (B1-occlusal view of the second premolar, B2-occlusal
view of the first molar, B3- occlusal view of the second molar, B4-gingival view). All scenarios that were applied under oblique loading: von Mises
stress analysis in Model 1 (C1-occlusal view, C2-gingival view); von Mises stress analysis in Model 2 (D1-occlusal view of the second premolar,
D2-occlusal view of the first molar, D3- occlusal view of the second molar, D4-gingival view).
A1A2
B1B2
B3B4
C1C2
D1D2
D3D4
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Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
and all ceramics. Finite element analysis showed
that the restorative materials did not affect the
bone tissue. In addition, Papavasiliou et al. [12]
found that different restorative materials did
not signicantly affect the stresses around the
bone-implant interface. Kaleli et al. [7] used
FEA to model implant-supported second molar
crown prostheses and tested monolithic
zirconia, lithium disilicate, and hybrid ceramic.
The analyses revealed that the different materials
evaluated did not affect the implant or the
bone. Furthermore, Sevimay et al. [29] showed
that different restorative materials made of
porcelain and all-ceramic with two different
metal substructures did not affect the stresses
on the bone or implant. In another FEA study,
Stegaroiu et al. [11] investigated the stresses
around implant-supported fixed prostheses
made from gold alloys, composite resins, and
porcelains. They found that the stress formation
in gold alloy and porcelain restorations was
similar. In agreement with the literature, different
restorative materials generated comparable
stress values at the implant-bone interface in
this study. Several components transmit forces
to the implant-bone interface, including crowns,
screws, abutments, and cement. In particular,
the abutment-implant interface transfers energy
to the implant-bone interface, and the structures
in between absorb some of the energy [13].
This theory explains the similar biomechanical
responses to different restorative materials.
A possible advantage of splinted implant-
supported restorations is that the loads are
distributed across implants. Theoretically, this
may reduce the stresses between the implant and
bone tissue, especially in areas where occlusal
forces are high [14]. When a single crown
is loaded in a splinted prosthesis design, the
unloaded components may redistribute forces
through the implant [16]. This was avoided by
applying force to the functional tubercles and
central fossa of each crown in the present study.
Wang et al. [13] and Lemos et al. [14] reported
that splinted prostheses were more suitable for
patients with poor bone quality, and also provides
uniform stress distribution [15]. The results of the
current study showed that the splinted prosthesis
design resulted in favorable stress formation on
the bone and restorations under oblique loading.
In a retrospective clinical study, Naert et al. [17]
observed increased implant loss with a splinted
prosthesis design. This may be explained by
Jemt and Book’s [31] hypothesis that biological
complications may occur if prostheses do not have
a passive t. In the current study, the splinted
prosthesis design generated greater stress on the
implants. Although various prosthesis designs
lead to different stress distributions on the bone
and implant, both prosthesis designs are suitable
for clinical use because the stresses are within
physiological limits [12]. Adhesive cementation
is recommended for all-ceramic restorations to
increase the fracture strength. The present study,
as well as previous studies [7,13,28], considered
the elastomeric properties and thickness of the
resin cement.
Several limitations are inherent in this study
that warrant consideration. Firstly, the stress
distribution ndings may not fully capture the
nuanced variations associated with different
bone densities, as the jaw models utilized in
this investigation were of standard density.
Secondly, the study adopted a uniform occlusal
geometry, potentially overlooking diverse stress
patterns that could arise from variations in
occlusal congurations. Moreover, nite element
analysis (FEA) assumes linear, homogeneous, and
isotropic properties in models, yet the real clinical
environment is notably heterogeneous. Despite
assuming 100% osseointegration for all implants,
the clinical reality of varied osseointegration
levels remains unaccounted for in the models
and calculations. Additionally, the study applied
forces vertically and obliquely, while recognizing
that incorporating horizontal forces would
be more representative of the complex oral
environment. Therefore, the outcomes of this
investigation should be interpreted with caution,
acknowledging the inherent limitations associated
with in vitro experiments.
CONCLUSIONS
This study provides crucial insights the
occurrence of stresses implant-supported
prostheses. In every investigated scenario, the
oblique loading generated more stress. The type
of restorative material did not significantly
affect the stress distribution in the supporting
bone and implant. Resin-inltrated restorative
materials generate favorable stresses in prosthesis
limitations, particularly in marginal nish areas.
The splinted prosthesis design resulted in less
stress on bone support. a splinted design may
be preferable in the presence of parafunctional
11
Braz Dent Sci 2024 Apr/June;27 (2): e4168
Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
habits. Overall, the results for the splinted and
non-splinted prosthesis designs were comparable.
Author’s Contributions
SDI: Conceptualization, Methodology,
Software, Validation, Formal Analysis, Investigation,
Resources, Data Curation, Writing – Original
Draft Preparation, Writing – Review & Editing,
Visualization, Supervision, Project Administration.
VT: Supervision, Project Administration. FBT:
Conceptualization, Methodology, Software,
Validation, Formal Analysis, Investigation,
Visualization, Supervision, Project Administration.
Conict of Interest
The authors declare that there are no
conicts of interest regarding the publication of
this paper.
Funding
This research was conducted as part of a
doctoral thesis, funded by the Istanbul University
Scientic Research Projects Committee (Grant
Number 35257).
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies of:
Clinical Research Ethics Committee of Istanbul
University.
The approval code for this study is 2019/40.
REFERENCES
1. Thome G, Caldas W, Vianna CP, Cartelli CA, Trojan LC. Surgical
and prosthetic outcomes of 967 implants under immediate or
delayed loading in full-arch rehabilitation: a retrospective study
with up to 5 years of follow-up. Braz Dent Sci. 2021;24(3):1-7.
http://dx.doi.org/10.14295/bds.2021.v24i3.2403.
2. Andrade GS, Kalman L, Giudice RL, Adolfi D, Feilzer AJ, Tribst JP.
Biomechanics of implant-supported restorations. Braz Dent Sci.
2023;26(1):e3637. http://dx.doi.org/10.4322/bds.2023.e3637.
3. Ahmed MAMH, Hamdy AM, Fattah GA, Elfadl AKA. Effect
of prosthetic design and restorative material on the stress
distribution of implant-supported 3-unit fixed partial dentures:
3D-FEA. Braz Dent Sci. 2022;25(4):e3523. http://dx.doi.
org/10.4322/bds.2022.e3523.
4. Ahmed MA, Hamdy AM, Fattah GA, Effadl AK. Prosthetic
design and restorative material effect on the biomechanical
behavior of dental implants: strain gauge analysis. Braz Dent
Sci. 2022;25(3):e3380. http://dx.doi.org/10.4322/bds.2022.
e3380.
5. Sheridan RA, Decker AM, Plonka AB, Wang HL. The role of
occlusion in implant therapy: a comprehensive updated review.
Implant Dent. 2016;25(6):829-38. http://dx.doi.org/10.1097/
ID.0000000000000488. PMid:27749518.
6. Almeida DAF, Pellizzer EP, Verri FR, Santiago JF Jr, Carvalho
PS. Influence of tapered and external hexagon connections on
bone stresses around tilted dental implants: three-dimensional
finite element method with statistical analysis. J Periodontol.
2014;85(2):261-9. http://dx.doi.org/10.1902/jop.2013.120713.
PMid:23688104.
7. Kaleli N, Sarac D, Kulunk S, Ozturk O. Effect of different
restorative crown and customized abutment materials
on stress distribution in single implants and peripheral
bone: a three-dimensional finite element analysis study. J
Prosthet Dent. 2018;119(3):437-45. http://dx.doi.org/10.1016/j.
prosdent.2017.03.008. PMid:28645667.
8. Paes TJA Jr, Tribst JP, Piva AM, Figueiredo VM, Borges AL, Inagati
CM. Influence of fibromucosa height and loading on the stress
distribution of a total prosthesis: a finite element analysis. Braz
Dent Sci. 2021;24(2):1-7. http://dx.doi.org/10.14295/bds.2021.
v24i2.2144.
9. Ganesan L, Murugaian J, Shankar MSS, Annapoorni H. A
comparative evaluation of stress distribution between an All-
on-Four implant-supported prosthesis and the Trefoil implant-
supported prosthesis: a three-dimensional finite element
analysis study. J Indian Prosthodont Soc. 2022;22(1):56-64.
http://dx.doi.org/10.4103/jips.jips_203_21. PMid:36510948.
10. Khazaei S, Iranmanesh P, Abedian A, Nasri N, Ghasemi E. Stress
analysis of different prosthesis materials in implant-supported
fixed dental prosthesis using 3D finite element method. Dent
Hypotheses. 2014;5(3):109-14. http://dx.doi.org/10.4103/2155-
8213.136757.
11. Stegaroiu R, Kusakari H, Nishiyama S, Miyakawa O. Influence of
prosthesis material on stress distribution in bone and implant:
a 3-dimensional finite element analysis. Int J Oral Maxillofac
Implants. 1998;13(6):781-90. PMid:9857588.
12. Papavasiliou G, Kamposiora P, Bayne SC, Felton DA. Three-
dimensional finite element analysis of stress-distribution
around single tooth implants as a function of bony support,
prosthesis type, and loading during function. J Prosthet
Dent. 1996;76(6):633-40. http://dx.doi.org/10.1016/S0022-
3913(96)90442-4. PMid:8957790.
13. Wang TM, Leu LJ, Wang J, Lin LD. Effects of prosthesis materials
and prosthesis splinting on peri-implant bone stress around
implants in poor-quality bone: a numeric analysis. Int J Oral
Maxillofac Implants. 2002;17(2):231-7. PMid:11958406.
14. Lemos CAA, Verri FR, Santiago JF Jr, Batista VES, Kemmoku DT,
Noritomi PY,etal. Splinted and nonsplinted crowns with different
implant lengths in the posterior maxilla by three-dimensional
finite element analysis. J Healthc Eng. 2018;2018:3163096.
http://dx.doi.org/10.1155/2018/3163096. PMid:30254726.
15. Clelland NL, Seidt JD, Daroz LG, McGlumphy EA. Comparison
of strains for splinted and nonsplinted implant prostheses
using three-dimensional image correlation. Int J Oral Maxillofac
Implants. 2010;25(5):953-9. PMid:20862409.
16. Guichet DL, Yoshinobu D, Caputo AA. Effect of splinting and
interproximal contact tightness on load transfer by implant
restorations. J Prosthet Dent. 2002;87(5):528-35. http://dx.doi.
org/10.1067/mpr.2002.124589. PMid:12070516.
17. Naert I, Koutsikakis G, Duyck J, Quirynen M, Jacobs R, van
Steenberghe D. Biologic outcome of implant-supported
restorations in the treatment of partial edentulism. Part
I: a longitudinal clinical evaluation. Clin Oral Implants
12
Braz Dent Sci 2024 Apr/June;27 (2): e4168
Inci SD et al.
Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design
Inci SD et al. Stress distribution in peri-implant bone, implants, and
prostheses: 3D-FEA of marginal bone loss and prosthetic design
Şehrize Dilara Inci
(Corresponding address)
Istanbul University, Department of Prosthodontics, Istanbul, Turkey.
Email: dtdilarauguz@gmail.com
Date submitted: 2023 Nov 28
Accept submission: 2024 Jan 26
Res. 2002;13(4):381-9. http://dx.doi.org/10.1034/j.1600-
0501.2002.130406.x. PMid:12175375.
18. Singh P, Wang C, Ajmera DH, Xiao SS, Song J, Lin Z. Biomechanical
effects of novel osteotomy approaches on mandibular
expansion: a three-dimensional finite element analysis. J Oral
Maxillofac Surg. 2016;74(8):1658.e1. http://dx.doi.org/10.1016/j.
joms.2016.04.006. PMid:27182974.
19. Manzoor B, Suleiman M, Palmer RM. The effects of simulated
bone loss on the implant-abutment assembly and likelihood
of fracture: an in vitro study. Int J Oral Maxillofac Implants.
2013;28(3):729-38. http://dx.doi.org/10.11607/jomi.2819.
PMid:23748303.
20. Tribst JPM, Dal Piva AMO, Ozcan M, Borges ALS, Bottino MA.
Influence of ceramic materials on biomechanical behavior of
implant supported fixed prosthesis with hybrid abutment. Eur
J Prosthodont Restor Dent. 2019;27(2):76-82. http://dx.doi.
org/10.1922/EJPRD_01829Tribst07. PMid:31046208.
21. Alamoush RA, Silikas N, Salim NA, Al-Nasrawi S, Satterthwaite
JD. Effect of the composition of cad/cam composite blocks
on mechanical properties. BioMed Res Int. 2018;2018:4893143.
http://dx.doi.org/10.1155/2018/4893143. PMid:30426009.
22. Tribst JPM, Dal Piva AMO, Anami LC, Borges ALS, Bottino MA.
Influence of implant connection on the stress distribution
in restorations performed with hybrid abutments. J
Osseointegration. 2019;11(3):507-12.
23. Zhong J, Guazzato M, Chen J, Zhang Z, Sun G, Huo X,etal. Effect
of different implant configurations on biomechanical behavior
of full-arch implant-supported mandibular monolithic zirconia
fixed prostheses. J Mech Behav Biomed Mater. 2020;102:103490.
http://dx.doi.org/10.1016/j.jmbbm.2019.103490. PMid:31877512.
24. Borie E, Orsi IA, de Araujo CP. The influence of the connection,
length and diameter of an implant on bone biomechanics. Acta
Odontol Scand. 2015;73(5):321-9. http://dx.doi.org/10.3109/0
0016357.2014.961957. PMid:25598357.
25. Kitamura E, Stegaroiu R, Nomura S, Miyakawa O. Biomechanical
aspects of marginal bone resorption around osseointegrated
implants: considerations based on a three-dimensional finite
element analysis. Clin Oral Implants Res. 2004;15(4):401-
12. http://dx.doi.org/10.1111/j.1600-0501.2004.01022.x.
PMid:15248874.
26. Smedberg JI, Nilner K, Rangert B, Svensson SA, Glantz SA.
On the influence of superstructure connection on implant
preload: a methodological and clinical study. Clin Oral Implants
Res. 1996;7(1):55-63. http://dx.doi.org/10.1034/j.1600-
0501.1996.070107.x. PMid:9002823.
27. Eskitascioglu G, Usumez A, Sevimay M, Soykan E, Unsal
E. The influence of occlusal loading location on stresses
transferred to implant-supported prostheses and supporting
bone: a three-dimensional finite element study. J Prosthet
Dent. 2004;91(2):144-50. http://dx.doi.org/10.1016/j.
prosdent.2003.10.018. PMid:14970760.
28. Ding X, Liao SH, Zhu XH, Zhang XH, Zhang L. Effect of
diameter and length on stress distribution of the alveolar
crest around immediate loading implants. Clin Implant Dent
Relat Res. 2009;11(4):279-87. http://dx.doi.org/10.1111/j.1708-
8208.2008.00124.x. PMid:18783411.
29. Sevimay M, Usumez A, Eskitascioglu G. The influence of
various occlusal materials on stresses transferred to implant-
supported prostheses and supporting bone: a three-dimensional
finite-element study. J Biomed Mater Res B Appl Biomater.
2005;73(1):140-7. http://dx.doi.org/10.1002/jbm.b.30191.
PMid:15742379.
30. Akça K, Iplikcioglu H. Finite element stress analysis of the effect
of short implant usage in place of cantilever extensions in
mandibular posterior edentulism. J Oral Rehabil. 2002;29(4):350-
6. http://dx.doi.org/10.1046/j.1365-2842.2002.00872.x.
PMid:11966968.
31. Jemt T, Book K. Prosthesis misfit and marginal bone loss in
edentulous implant patients. Int J Oral Maxillofac Implants.
1996;11(5):620-5. PMid:8908860.