RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA BANGALORE ANNEXURE-II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

Name of the candidate (in block letters) Permanent Address

DR. KARTHIKEYAN. I 13/5, SOMESWARAN KOIL STREET, PANRUTI-607106, CUDDALORE DISTRICT, TAMIL NADU H.K.E. SOCIETYS S.NIJALINGAPPA INSTITUTE OF DENTAL SCIENCE, GULBARGA Master of Dental Surgery- Periodontia 2 ND MAY 2009 A comparative study of single versus double implants for replacing mandibular molar : A Three-Dimensional Finite Element Analyses

2. 3. 4. 5.

Name of the Institution Course of study and Subject Date of admission to the Course Title of Topic

6.

Brief resume of intended work: 6.1 Need of study : Dental implant treatment has become popular for the oral rehabilitation, replacing conventional dental treatments.1-3 Oral implantology tends to evolve into a less timeconsuming, a more aesthetic and a less invasive way to restore a lost dentition.4 Single implants replacing molar are a valid and lasting treatment alternative to conventional prosthesis and have advantage of reducing alveolar ridge resorption5 but have an especially high risk of screw loosening, even with non-rotating abutments and implant fracture.6 The finite-element method (FEM) has been a useful tool in studying the bone to implant interface under mechanical loading.7 FEM studies have shown that peak stresses/strains occur at the most occlusal crestal point on the cortical bone around endosseous implants8-9 and also evaluates and compares the effects of different implant cross-sectional designs on the surrounding bone stress and strain levels, under different loading patterns.10 Although wide diameter implants are suitable alternative for replacing missing molar, a single implant for a molar does not replace the crown to root ratio and may subject the implant to overload. However the use of two implants have biomechanical advantage of better mesiodistal support for the artificial crown11-12 and provide more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration..13,14 On contrary, study done by Sato et al. has shown

that in the double implants, load near the marginal ridge of the superstructure generated large lateral and vertical forces on the implant leading to higher marginal bone loss.6 Further study is needed for evaluating bone response, to wide implant in comparison of double implants to validate the success in usage of double implants option.14 The purpose of this study is to compare a finite element model of double implants versus different diameters of single implant in place of mandibular molar with induced displacements & stresses under various loading conditions. . 6.2 Review of Literature Thomas J. Balshi et al.13 demonstrated the clinical feasibility of placing two implants to support a molar restoration and compared this treatment option to the use of a single standard implant or a wide-diameter implant The use of two implants provides more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration.

Mithridade Davarpanah et al.16 suggested that wide diameter implants can be used for better prognosis in cases in which the condition of the supporting bone is unfavorable. The short and medium term results are satisfactory to optimize the functional and esthetic result with technical improvements associated with different shapes and materials.

Wook-jin Seong et al.15 studied the effects of 3 single molar implant designs on implant strains under a variety of homologous loading conditions with 4 strain gauges were placed axially at 90 degrees to each other on the buccal, lingual, mesial, and distal surfaces on (1) single 3.75 mm (regular) diameter implant, (2) single 5 mm (wide) diameter implant, and (3) two 3.75 mm diameter (double) implants connected through a single molar crown determined that an increase in implant number and diameter may effectively reduce experimental implant abutment strains.

Y. Sato et al. 6 evaluated the effectiveness of double implants versus a wide implant. The vertical forces and torque on each implant were calculated by three dimensional geometric analysis and three implants were compared: mesial and distal double implants (33 mm), a wide implant (5 mm) with 3 kinds of load points 1.5, 3.5 and 5.5 mm from mesial contact point respectively resulting in vertical force concentrated more at a point in double implants compared to single implant leading to perimplant bone stress suggesting biomechanical advantage of double implants for single molar replacement questionable when occlusal forces are loaded at the occlusal surface near the contact point.

6.3

7.

Objectives of the study The objective of this study is to develop a finite element model of a mandibular molar crown supported by a (1) Standard 3.75-mmdiameter implant, (2) 5 mm, wide diameter implant, (3) 6 mm wide diameter implant (4) Double standard 3.75mm - diameter implants, and to compare the induced displacements and stresses as a result of various loading conditions. Materials and Methods 3D Finite element models will be developed to simulate the 3 molar implant designs. The first model uses a 3.75 mm diameter implant to support a molar crown, the second model contains a 5 mm diameter implant & the third model contains a 6 mm. The fourth model (doubleimplant design) contains 2 implants, each 3.75 mm in diameter. The only difference between these 4 models is the number and the diameter of the implants. The length of all implants will be 10 mm. Each model analysis would be done with 2 force magnitudes (35N and 70N) and with 2 force directions (vertical and in oblique direction to the vertical axis to produce a buccolingual direction of force). Loads will be applied at 3 different locations (1) the central fossa, (2) the buccolingual midpoint of the distal marginal ridge, and (3) the distobuccal cusp tip.15 The modeling and analyses will be accomplished with a software program (ANSYS WORK BENCH Version 11). The material properties will be assigned. Displacements & stresses at the location of force application will be evaluated along 3 main axes (mesiodistal, faciolingual, and superior-inferior). 7.1 Source of Data . 7.2 Methods of collection of Data Does the study require any investigation to be carried out in humans? No Has ethical clearance have been obtained from college? Yes

7.3

7.4

8.

List of References 1. Cannizzaro G, Leone M, Esposito M. Immediate functional loading of implants placed with flapless surgery in theedentulous maxilla: 1-year follow-up of a single cohort study. Int J Oral Maxillofac Implants. 2007;22:8795. 2. Zeren KJ. Minimally invasive extraction and immediate implant placement: the preservation of esthetics. Int J Periodontics Restorative Dent. 2006;26:171181. 3. Henry PJ. Oral implant restoration for enhanced oral function. Clin Exp Pharmacol Physiol. 2005;32:123127. 4. Tommie Van de Velde, Fadi Glor, Hugo De Bruyn. A model study on flapless implant placement by clinicians with a different experience level in implant surgery Clin Oral Impl Res. 19, 2008; 6672. 5. Robert Haas, Nikoletta Mensdorff-Pouilly, Georg Mailath, Georg Watzek Branemark single tooth implants: A preliminary report of 76 implants. J Prosthet Dent 1995; 73; 274-9.

6. Y. Sato, N. Shindoi, R. Hosokawa, K. Tsuga, Y. Akagawa. Biomechanical effects of double or wide implants for single molar replacement in the posterior mandibular region. Journal of Oral Rehabilitation 2000; 27; 842845. 7. Geng JP, Tan KBC & Liu GR.Application of finite element analysis in implant dentistry: a review of the literature. Journal of Prosthetic Dentistry 2001 85: 585598. 8.Holmgren EP, Seckinger RJ, Kilgren LM. & Mante F. Evaluating parameters of osseointegrated dental implants using finite element analysis a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction. Journal of Oral Implantology 1998;24: 8088. 9. Hoshaw SJ, Brunski JB & Cochran GVB. Mechanical loading of Branemark implants affects interfacial bone modeling and remodeling. International Journal of Oral & Maxillofacial Implants 1994;9: 345360. 10. Osama Abu-Hammad, Ameen Khraisat, Najla Dar-Odeh, Mohammed El-Maaytah. Effect of Dental Implant Cross-Sectional Design on Cortical Bone Structure Using Finite Element Analysis Clinical Implant Dentistry and Related Research, Volume 9, Number 4, 2007. 11. Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part II: The prosthetic results. J Prosthet Dent 1990;64:53-61. 12. Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part III: Problems and complications encountered. J Prosthet Dent 1990;64:185-94. 13. Balshi T J First molar replacement with an osseointegrated implant quintessence int 1990; 21:61-65 14. Thomas J. Balshi, Glenn J. Wolfinger. Two-Implant-Supported Single Molar Replacement: Interdental Space Requirements and Comparison to Alternative Options. Int J Periodont Rest Dent 1997; 17:427-435.) 15. Seong WJ, Korioth TW, Hodges JS. Experimentally induced abutment strains in three types of single-molar implant restorations. J Prosthet Dent 2000;84:318-26. 16. Mithridade Davarpanah, MD, DDS, Henry Martinez, DDS, Myriam Kebir, DDS, Daniel Etienne, DDS, Jean-Franois Tecucianu, MD, DDS Wide-Diameter Implants: New Concepts International Journal of Periodontics and Restorative Dentistry March/April 2001 Volume 21

9.

Signature of Candidate

10.

Remarks of guide

11

11.1

Name and Designation of the Guide (in block letters)

Dr. SHRIKAR R. DESAI MDS Associate Professor Department of Periodontics

11.2

Signature

11.3

Head of the Department

Dr. (Mrs.) VEENA A. PATIL MDS PROF. & HOD Department of Periodontics

11.4

Signature

12

12.1

Remarks of Chairman and Principal

12.2

Signature