J Periodontol • January 2010

Evaluation of Stress Induced by Implant

Type, Number of Splinted Teeth, and
Variations in Periodontal Support in
Tooth-Implant–Supported Fixed
Partial Dentures: A Non-Linear
Finite Element Analysis
Chun-Li Lin,* Jen-Chyan Wang,† Shih-Hao Chang,‡ and Shiang-Ting Chen§

Background: This study investigated the biomechanical interac-

tions in tooth-implant–supported fixed partial dentures (FPDs) with
variations in periodontal support, implant system, number of splinted
teeth, and load type using the non-linear finite element (FE) approach.
Methods: The section contours of the alveolar bone, abutment teeth,
and prosthesis were acquired using computed tomography (CT) and
micro-CT to construct the FE models with normal periodontal support

T
he high success rate
(NPS) and compromised periodontal support (CPS) containing one- achieved by osseointe-
and two-piece implants splinted to the first and second premolars. Re- grated dental implants is
alistic interface conditions within the implant system were simulated an accepted clinical reality.1,2
using frictional contact elements. The main effects for each level of in- However, a controversy emerged
vestigated factors in terms of stress values and dissimilar mobility of regarding whether implants should
natural teeth and the implant were computed for all models. be connected to natural teeth in
Results: Analytic results indicated that the load condition was the anatomically limited areas or
predominant factor affecting stress developed in the implant, bone, whether implants should be self-
and prosthesis. Additionally, the oblique occlusal forces increased the supporting.3-5 A biomechanical
stress values relative to that of axial analogs. A splinted system with dilemma for a tooth-implant–
a two-piece implant increased stress on the bone and decreased stress supported fixed partial denture
on the prosthesis compared to that of the one-piece implant. The (FPD) results from the dissimilar
splinted system with a CPS only slightly increased implant stress on mobility between an osseointe-
the bone compared to that of the splint system with NPS. Splinting an grated implant and natural teeth.
additional tooth did not significantly impact stress values for the When there is excessive occlusal
tooth-implant–supported FPD. force on an FPD, a movement dis-
Conclusions: A one-piece structure implant may be better than that parity can cause a higher bend-
of a two-piece structure implant in decreasing bone stress when a ing moment at the implant site,
natural tooth is planned to connect with an implant. The factors of peri- loss of osseointegration, and
odontal support and number of splinted teeth only slightly influenced increased marginal bone loss
stress in tooth-implant–supported FPDs. J Periodontol 2010;81:121- around the implant.6-9 Engi-
130. neering complications, such as
an abutment screw loosening
KEY WORDS
(screw-retained) or implant or
Alveolar bone loss; biomechanics; dental implants; dental stress prosthesis fracture, can also oc-
analysis; dentures; finite element analysis. cur under long-term loading.4,5
Non-rigid connectors have
been used to compensate for
* Department of Mechanical Engineering, Chang Gung University, Tao-yuan, Taiwan.
† Department of Prosthodontics, School of Dentistry, Kaohsiung Medical University, Kaohsiung Medical the variance in mobility; however
University Hospital, Kaohsiung, Taiwan.
‡ Department of Periodontics, Chang Gung Memorial Hospital, Tao-yuan, Taiwan.
§ Graduate Institute of Medical Mechatronics, Chang Gung University.
doi: 10.1902/jop.2009.090331

121
Stress Induced by Tooth-Implant–Supported Fixed Partial Dentures
non-rigid implants are associated with intrusion in
20% of cases.10 There have been minimal differences
found between the two connection systems.10-13 In
finite element (FE) analysis, non-rigid connectors
perform well when the load is on the natural teeth,
but unfavorable stress values remain in the prosthe-
sis.14,15 Therefore, tooth-implant prostheses used
with a rigid connection were advocated by certain
authors,3,16-18 as the prosthesis and implant have
an inherent flexibility that accommodates dissimilar
mobilities. However, several studies3-5,14 showed that
a rigid connector could avoid abutment-teeth intru-
sion but significantly increased bone loss can occur
around connected implants. These results suggest
that other factors such as occlusal loading, implant
type, number of splinted teeth, and periodontal sup-
port may be related to biomechanical complications
in implant-teeth (splinting) systems.
Lang et al.5 and Pjetursson et al.19 conducted sys-
tematic reviews that indicated survival rates for both
implants, and reconstructions in combined tooth-
implant–supported FPDs were lower than those reported
for solely implant-supported FPDs. Intrusion was de-
tected in 5.2% of abutment teeth among non-rigid con-
nections after a 5-year period.5,19 It was suggested that
solely implant-supported FPDs are preferable; however,
there may be anatomic or patient-centered reasons
that prevent this from being feasible. The authors’ rec-
ommendation would be to use the common method of
combining tooth-implant–supported FPDs in a rigid
connection with two abutments to decrease stress
and reduce mobility.13,20-22 However, the effects of
the number of splinted teeth and compromised peri-
odontal support (CPS) levels in implant-teeth splint
systems have not been adequately investigated.
Despite the advantages of FE technology, am-
biguous simulation results may occur as a result
of inaccurate three-dimensional (3D) FE model
geometry.10,20-22 Integrating advanced engineering
techniques, such as microcomputed tomography
(micro-CT) images and computer-aided design
(CAD) systems to construct accurate FE models
are needed to calculate the detailed mechanical char-
acteristics. Given the paucity of information evaluat-
ing the relative influence of loading, periodontal
condition, and implant macrostructure contributing
to the optimal stress distribution in rigidly connected
tooth-implant–supported FPDs, identification of the
important factors will certainly extend existing knowl-
edge in the decision-making and reconstruction de-
sign for patients and dental practitioners. Therefore,
the objectives of this study are to investigate the
mechanical interactions in an implant-teeth splint
system with different periodontal supports and con-
sider the number of teeth splinted with two implant
systems using non-linear FE analysis.
122
Volume 81 • Number 1
MATERIALS AND METHODS
FE Model of the Tooth-Implant
Connection System
A four-unit, 3D normal periodontal support (NPS)
model comprising an implant, natural teeth (first
and second premolars), periodontal ligament, alveo-
lar bone (cortical and cancellous), and an FPD was
constructed for computer simulations.
Figure 1 shows the schematic procedure for the
solid-model generation. For teeth and prosthesis
(FPD) construction, two freshly extracted intact first
and second premolars were embedded in an epoxy
resini block up to 1 mm below the cemento-enamel
junction. After tooth preparation, wax-up, and casting
procedures, a type II gold-alloy, four-unit FPD from
the first premolar to the second molar was fabricated
and fixed onto natural teeth with adhesive. The teeth
cemented with the FPD system were scanned using
high-resolution micro-CT¶ with a voxel dimension of
38 mm. In total, 1,055 slices were obtained, and only
211 slices (one of every five slices) were used during
modeling. For alveolar bone generation, a series of CT
images# with a 1-mm interval of the posterior edentu-
lous mandibular model with NPS by a dry human skull
were obtained from the first premolar to the second
molar. All cross-sections of the micro-CT and CT im-
age images were processed on a personal computer
using commercially available image-processing soft-
ware** that allowed for identification of the contours
of different hard tissues (dentin, pulp, prosthesis, NS
cortical, and cancellous bone), which were extracted
and converted into mathematic entities. The coordi-
nates of each point on the contours were input into
the FE program†† to generate solid models. Based
on the root-form geometry of premolars, simplified
0.3-mm periodontal ligaments were created accord-
ing to the literature (Fig. 1).23
A two-piece implant with a taper integrated screwed-
in (TIS) connection‡‡ and a one-piece implant§§ were
selected as the implant systems for investigation.
Solid models of the implant systems were constructed
using a CAD systemii and imported into the FE
program and placed in the second molar position
to complete the splint system solid model (Fig. 1).
Two mesh models were generated with a quadratic
10-node tetrahedral structural solid element¶¶ after
the mesh convergence test while controlling the strain
i Truetime Industrial, Taipei, Taiwan.
¶ Skyscan 1072, Skyscan, Aartselaar, Belgium.
# LightSpeed Plus, GE Medical System, Midland, TX.
** Amira, v4.1, Mercury Computer Systems, Chelmsford, MA.
†† ANSYS, v11.0, Swanson Analysis, Houston, PA.
‡‡ 4.1 mm in diameter and 12 mm in sand-blasted large grift acid-etched
length, ITI, Institute Straumann, Waldenburg, Switzerland.
§§ 4.1 mm in diameter and 13 mm in length, PrimaSolo, Lifecore,
Biomedical, Chaska, MN.
ii Pro/Engineer, Parametric Technology, Boston, MA.
¶¶ Solid 92 (10 node quadratic tehrahedral structural solid element
provided in ANSYS).
J Periodontol • January 2010
Figure 1.
Schematic procedure for solid-model generation for tooth-implant–supported FPDs.
energy and displacement variations of <5% for models
with different element sizes. Non-linear frictional con-
tact elements (defined as surface to surface) were
used to simulate the adaptation between the abut-
ment and fixture within the two-piece (TIS) implant.
A friction coefficient of 0.5 was assumed for all
contact surfaces.14,24 The tooth-implant–supported
FPD FE models with NPS consisted of 219,938
tetrahedral elements, 2,651 contact elements, and
303,482 nodes for the two-piece implant and
236,734 tetrahedral elements and 327,169 nodes
for the one-piece implant (Figs. 2A through 2C).
Periodontal Supports, Teeth Splinting, and
Loading Conditions
To generate the alveolar bone solid model with CPS,
the previous alveolar bone surface model with NPS
was modified by image-processing software## to fit
the condition of a 1:1 crown/root ratio. Then, the solid
model of the alveolar bone with CPS was constructed
by the FE package*** and assembled with teeth
(first and second premolars), the prosthesis, and im-
plants to generate the CPS FPDs. After the mesh
convergence test, the CPS FE models consisted
of 202,672 tetrahedral elements, 2,134 contact
elements, and 281,053 nodes for the two-piece im-
plant and 185,593 tetrahedral elements and 257,903
nodes for the one-piece implant (Fig. 2D).
To determine the influence of the number of
splinted teeth used in splint systems, the previous
Lin, Wang, Chang, Chen
two teeth-implant–connected FE models (NPS and
CPS) were modified and extended to match the num-
ber of splinting teeth in parametric analyses. One or
two natural teeth were splinted to examine their inter-
actions by deleting connector elements between the
first and second premolar in the two FE models. Uni-
form multiple axial (load type 1) and oblique contacts
(load type 2) on premolars (200 N), pontic (200 N),
and molar (200 N) were applied on the models as
the load conditions (Figs. 2C and 2D). The mesial
and distal exterior nodes of the bony segment were
fixed in all directions as boundary conditions. We as-
sumed linear elastic, homogeneous, and isotropic
material properties of the dental tissue, periodontal
ligament, prosthesis, and implant system in simula-
tions, as adopted from relevant literature14,25-27
(Table 1). Therefore, 16 FE models in total were an-
alyzed with two periodontal supports, two implant
systems, two splinting scenarios, and two load
conditions for determining mechanical interactions
(Table 2). The maximum von Mises stress values
and distributions in the implant system, alveolar
bone, and prosthesis were recorded for all models.
The multifactor analysis of variance (ANOVA) test
was applied to determine the relative importance
of investigated factors and their interactions.
The main effect of each level of the four factors
## Amira, v4.1, Mercury Computer Systems.
*** ANSYS, v11.0, Swanson Analysis.
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Stress Induced by Tooth-Implant–Supported Fixed Partial Dentures Volume 81 • Number 1

RESULTS
The simulated results showed that load
condition significantly (P <0.05) influ-
enced the magnitude of stress values;
the percentage contributions were 52%
for the implant, 79% for bone, and
55% for the prosthesis (Table 3). Gen-
erally, oblique occlusal forces (load
type 2) increased the stress relative
to that of axial analogs (load type 1)
(Fig. 3A). The implant system was
the second factor influencing stress
values of the splint system. The per-
centage contributions were 12%, 10%,
and 26% for the implant, bone, and
prosthesis, respectively (Table 3).
The main effect plot showed that the
implant system did not affect average
implant stress; however, using a two-
piece implant (TIS connection) in-
creased stress on the bone more than
1.7-fold (218.41 versus 127.06 MPa)
and decreased stress on the prosthesis
relative to that by the one-piece im-
plant (Fig. 3B). The percentage contri-
butions indicate that the periodontal
support significantly (P <0.05) affected
stress values for the bone and implant;
Figure 2. the percentage contributions were 2%
A) FE mesh model for two-piece (TIS connection) and one-piece implant systems. B) Teeth and 11% for the bone and implant, re-
connected to the two-piece implant with a prosthesis. C) Teeth-implant–supported FPD with spectively (Table 3). The splint system
NPS and load conditions. D) Teeth-implant–supported FPD with NPS and load conditions. with CPS substantially increased im-
plant stress but only slightly increased
Table 1. bone stress when compared to that
with NPS (Fig. 3C). The ANOVA results
Material Properties Assigned to Alveolar showed that the number of splinted teeth did not sig-
Bone, Dental Tissues, Implant Material, nificantly impact stress on the implant, bone, and
and Prosthesis prosthesis (Table 3; Fig. 3D).
The sI, max (maximum stress in the implant) posi-
Young Poisson tions for the two- and one-piece implants were located
Materials Modulus (MPa) Ratio References at the mesial neck collar region of the implant and
Cortical bone 15,000 0.30 14
mesial prosthesis–abutment junction area of the im-
plant, respectively (Fig. 4A). The value of sI, max
Cancellous bone 1,500 0.30 14 in the two-piece implant exceeded 1,000 MPa when
Dentin 18,600 0.31 25 uniform multiple oblique forces (load type 2) acted
on the splint system when two teeth were splinted
Titanium (implant system) 110,000 0.35 26 (the model sequence was 10). The sAB, max (maxi-
Gold alloy (prosthesis) 90,000 0.30 26 mum stress in the alveolar bone) positions were at
the lingual cervical areas in the cortical bone on
Periodontal ligament 69 0.45 27 the implant side regardless of the load type acting
on the splint system (Fig. 4B). Depending on the
(implant system, periodontal support, number of implant used, the sP, max (maximum stress on the
splinted teeth, and load condition) on mechanical re- prosthesis excluding the load area) positions were
sponse (stress) was also computed using statistical located at the mesial prosthesis–abutment con-
methods.28 nected region of the two-piece implant and the

124
J Periodontol • January 2010 Lin, Wang, Chang, Chen

Table 2.
Detailed Periodontal Support, Splinting Situation, Implant System, Load Condition,
Sequence of Simulated FE Models, and Simulated Results of sI, max, sAB, max, and sP, max

Model Sequence Periodontal Support Splinting Situation Implant System Load Type sI, max (MPa) sAB, max (MPa) sP, max (MPa)

1 Crown/root ratio 1:2 (NPS) Two teeth Two-piece Axial 109.27 50.73 74.64
2 Crown/root ratio 1:2 (NPS) Two teeth Two-piece Oblique 417.02 318.02 238.79
3 Crown/root ratio 1:2 (NPS) Two teeth One-piece Axial 105.98 33.01 178.24

4 Crown/root ratio 1:2 (NPS) Two teeth One-piece Oblique 350.42 191.61 346.46
5 Crown/root ratio 1:2 (NPS) One tooth Two-piece Axial 117.28 53.39 88.27
6 Crown/root ratio 1:2 (NPS) One tooth Two-piece Oblique 431.92 324.21 242.01
7 Crown/root ratio 1:2 (NPS) One tooth One-piece Axial 101.33 33.83 168.22

8 Crown/root ratio 1:2 (NPS) One tooth One-piece Oblique 365.64 195.38 387.78
9 Crown/root ratio 1:1 (CPS) Two teeth Two-piece Axial 204.02 56.62 89.77
10 Crown/root ratio 1:1 (CPS) Two teeth Two-piece Oblique 1,077 437.64 198.74

11 Crown/root ratio 1:1 (CPS) Two teeth One-piece Axial 76.29 30.60 137.72
12 Crown/root ratio 1:1 (CPS) Two teeth One-piece Oblique 436.63 250.12 544.47
13 Crown/root ratio 1:1(CPS) One tooth Two-piece Axial 219.45 60.38 90.22

14 Crown/root ratio 1:1 (CPS) One tooth Two-piece Oblique 1,134 446.31 218.97
15 Crown/root ratio 1:1 (CPS) One tooth One-piece Axial 443.97 248.91 575.67
16 Crown/root ratio 1:1 (CPS) One tooth One-piece Oblique 74.94 33.00 133.99

mesial prosthesis–abutment junction of the one- supraocclusal contacts, predominately in a non-axial

piece implant (Figs. 4C and 4D).
DISCUSSION
This study investigated the impact of loading stress
around two implant systems (one- and two-piece sys-
tems) that connected teeth with different periodon-
tal statuses using 3D FE analysis. Numeric results
showed that occlusal loading and the implant macro-
structure (one-piece) were the principal factors im-
pacting bone stress, and the periodontal condition
had a less significant influence in rigid-connected
tooth-implant–supported FPD models.
Bone, as a living tissue, adapts to applied forces by
modeling and remodeling. However, instead of in-
creasing bone density under physiologic loading,
forces exceeding physiologic limits may result in bone
loss around dental implants.7-9,29 A number of au-
thors29-32 advocated in their early clinical studies that
implant loss can be attributed to overloading. Animal
studies2,3 demonstrated that excessive occlusal load-
ing may cause a loss of osseointegration along the
entire implant length, resulting in implant mobility.
Excessive occlusal loading was achieved by heavy
direction, for 18 implants placed in the mandible of
four monkeys, demonstrating that an excessive oc-
clusal load may lead to a loss of osseointegration,
which is characterized by a fibrous connective tissue
capsule around implants, whereas ligature-induced
peri-implantitis caused marginal bone loss.7 To our
knowledge, no experimental study has analyzed the
direct relationship among changes in stress and strain
in a loaded implant and/or tooth-implant–supported
system or analyzed the reactions of the surrounding
bone. However, with the help of accurate 3D FE ana-
lyses and computerized occlusal analysis systems, the
change in stress and stain in implants and surrounding
bone can be estimated. Therefore, the danger zones
for bone with resulting strain exceeding physiologic
limits can be identified.
Although FE analysis is generally accepted as
a complementary tool that enhances the understand-
ing of detailed mechanical responses in dental bio-
mechanics, constructing an accurate FE model with
detailed tooth/bone anatomy and realistic material
properties is necessary to ensure that simulation
results are clinically convincing.16,33,34 A previous

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Stress Induced by Tooth-Implant–Supported Fixed Partial Dentures Volume 81 • Number 1

Table 3.
Summary of the ANOVA Showing the Statistical Results of Maximum Stress With
Respect to the Implant, Alveolar Bone, and Prosthesis

Implant Alveolar Bone Prosthesis

Source % TSS P Value % TSS P Value % TSS P Value

Periodontal support 11 0.011 2 0.001 2 0.329

Splinting situation 0 0.802 0 0.620 0 0.711

Implant system 12 0.009 10 0.000 26 0.004
Load type 52 0.000 79 0.000 55 0.001

Periodontal support · splinting situation 0 0.920 0 0.998 0 1.000

Periodontal support · implant system 8 0.019 1 0.036 2 0.205
Periodontal support · load type 8 0.022 2 0.001 2 0.182

Splinting situation · implant system 0 0.860 0 0.774 0 0.934

Splinting situation · load type 0 0.863 0 0.885 0 0.713
Implant system · load type 5 0.040 6 0.000 8 0.039
Error 4 0 5

Total 100 100 100

% TSS = total of sum square.

FE-analysis study15 attempted to generate 3D lateral forces acting on a tooth-implant–supported

tooth-implant–supported FPD models to understand
the biomechanical behavior of different connectors.
However, a coarse tooth geometry and simple bone
geometry (block) were limitations of the geometric
acquisition method (manual tracing of actual tooth
sections) and cannot be used to simulate the effects
of different periodontal supports.14 In this study,
micro-CT and CT images were collected to acquire
detailed tooth and bone anatomy and generate a
realistic computational process. The precise ge-
ometry of the 3D model provided accurate anatomic
volumetrics for generating a fine meshing process.
Otherwise, non-linear contact analysis was validated
as a more realistic interfacial condition than linear
bonded for simulating compensative mechanisms
within an implant system.14 Consequently, accurate
tooth-implant–supported FPD FE models with appro-
priate interfacial conditions were used to simulate the
mechanical interactions in splint systems involving
multifactorial parameters.
Contact locations and the magnitude of load forces
may alter the mechanical responses in an implant-
tooth splint system. The two load types modeled in
the present study were simplified and could only sim-
ulate some possible axial and oblique occlusal con-
tacts encountered in clinical situations. Load types
1 and 2 represented uniform multiple vertical and
prosthesis adjusted to contact the maximal intercus-
pation and lateral working positions, respectively.
Simulation results indicated that load type had the
greatest contribution to implant stresses and alveolar
bone and prosthesis stresses (Table 3). Oblique oc-
clusal forces generated a lateral bending moment
that significantly increased stress when compared to
that generated by axial occlusal forces. The largest
stresses on the alveolar bone occurred on the lingual
side around the implant neck due to the primary bend-
ing moment acting on these areas when occlusal
forces distorted the entire splint system (load types
1 and 2).
From a mechanical perspective, stress concen-
trated on the implant side caused by a bending mo-
ment can induce a series of engineering problems
such as implant–abutment interface failure and
fracture. The present study selected two implant sys-
tems (one- and two-piece systems) to analyze their
characteristics in a splint system. Many different
connection methods are commonly used for two-
piece implants to secure an abutment to an implant,
such as a retaining screw, TIS, and a tapered inter-
ference fit. The TIS connection was selected for the
two-piece implant such that no microgap existed be-
tween the implant and abutment. This system was
used to determine the mechanical behaviors and

126
J Periodontol • January 2010
Figure 3.
Main effects of load type (A), implant system (B), periodontal support (C), and splinting situation (D) at each level for the maximum von Mises stress on the
implant, alveolar bone, and prosthesis.
compared to those of the one-piece implant in the
tooth-splinting system. Simulation results indicated
that the implant system used was the second most
important factor in the splint system. The stress
values of concentrated areas in the implant, bone,
and prosthesis depend on the implant type used.
The sI, max positions are usually near the branch point
of the bending moment in a splint system. The stress
concentrated at the mesial neck region of the two-
piece (TIS connection) implant created the most
stress, which was transferred to the surrounding bone
and thereby increased stress values (Fig. 4C). With
the one-piece implant, the corresponding concentra-
tions of stress were located at the mesial prosthesis–
abutment junction area of the implant, causing the
most stress, which was transferred from the implant
to the prosthesis (Fig. 4D). These analytic results ex-
plain why the two-piece implant increased stress
on the bone and decreased stress on the prosthesis
relative to those of the one-piece implant. This also
implies that using the one-piece implant may be a
better option when a natural tooth is connected with
an implant for patients with less than ideal implant
sites. This study indicates that combining a tooth with
one-piece implant-supported FPDs with an occlusal
Lin, Wang, Chang, Chen
scheme minimized oblique contacts in eccentric
movements and could have better stress distri-
bution. However, the benefits of this prosthetic design
must be confirmed in well-controlled, long-term
clinical trials.
Analytic results indicated that the periodontal sup-
port primarily influenced the stress in the alveolar
bone and implant; the corresponding percentage
contributions were only 2% and 11%, respectively
(Table 3). To compensate for instability in the splint
system, additional teeth were splinted to determine
the basic mechanism for different bony levels. How-
ever, adding an extra tooth did not significantly alter
the stress values in the tooth-implant–supported
FPD. These findings suggest that a periodontal com-
promised tooth with a crown/root ratio of 1:1 is still
valid as an abutment for connecting an implant. In
some clinical situations, extracting the abutment
tooth and replacing it with an implant may be a better
option than splinting with a second tooth.
Although accurate 3D tooth-implant–supported
FPD FE models were constructed to investigate
the basic mechanical interactions under NPS and
CPS using two implant systems for different splint-
ing situations, this investigation was limited by
127
Stress Induced by Tooth-Implant–Supported Fixed Partial Dentures Volume 81 • Number 1

erties in the literature,35,36 especially

those of periodontal ligament char-
acterization. Therefore, FE-analysis
modeling results only provided a
general insight into the biomechani-
cal aspects of the splint system
under average conditions. Because
some parameters that may influence
a clinical situation were excluded,
further long-term clinical studies
examining the correlation between
stress analysis and clinical outcome
of these tooth-implant–supported re-
constructions are warranted.

CONCLUSIONS
Based on the results of extensive 3D
non-linear numeric analyses, we con-
clude the following:
1) The loading condition and im-
plant macrostructure were the main
factors affecting the stress distribution
in the implant, alveolar bone, and pros-
thesis of a tooth-implant–supported
FPD compared to the periodontal sta-
tus of abutment teeth.
2) From a biomechanical perspec-
tive, using the one-piece implant may
be a better option to decrease bone
stress when a natural tooth is con-
nected with an implant.
3) A compromised periodontal sup-
port with a crown/root ratio of 1:1 only
Figure 4. slightly influenced the stress in the
A) von Mises stress distribution of the two-piece (left) and one-piece (right) implants in the splint bone and implant by simulation re-
system under load type 1 with a two-teeth splint under the NPS condition (models 1 and 3,
sults. Splinting an additional tooth had
respectively). Positions of sI, max were at the mesial neck region of the implant and mesial
prosthesis–abutment junction area of the implant. B) von Mises stress distribution of the alveolar no effect on the stress values in the
bone in the splint system under load type 2 with the NPS condition and splinting two teeth (model tooth-implant–supported FPD, at least
2). sAB, max positions at the lingual cervical areas in the cortical bone of the implant side. C) von in this FE model.
Mises stress distribution of the prosthesis in the splint system used a two-piece implant under load
type 1 with two teeth splinted and the NPS condition (model 1). sP, max was at the mesial
prosthesis–abutment connected region. D) von Mises stress distribution of the prosthesis in the ACKNOWLEDGMENT
splint system using a one-piece implant under load type 1 with two teeth splinted and the NPS
condition (model 3). sP, max was at the mesial prosthesis–implant connected area. The authors report no conflicts of
interest related to this study.

theoretic assumptions, including those of load con-

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130
Volume 81 • Number 1
Correspondence: Dr. Jen-Chyan Wang, Department of
Prosthodontics, School of Dentistry, Kaohsiung Medical
University, Kaohsiung Medical University Hospital, 100
Shih-Chuan 1st Rd., Kaohsiung 807, Taiwan. E-mail:
cgucaeb@yahoo.com.tw.
Submitted June 10, 2009; accepted for publication
September 16, 2009.