LITERATURE REVIEW

Use of Stress Analysis Methods to Evaluate the

Biomechanics of Oral Rehabilitation With Implants
Aldiéris Alves Pesqueira, DDS, MS, PhD1
Marcelo Coelho Goiato, DDS, MS, PhD2*
Humberto Gennari Filho, DDS, MS, PhD2
Douglas Roberto Monteiro, DDS, MS, PhD3
Daniela Micheline dos Santos, DDS, MS, PhD2
Marcela Filié Haddad, DDS, MS4
Eduardo Piza Pellizzer, DDS, MS, PhD2

Because the biomechanical behavior of dental implants is different from that of natural tooth, clinical problems
may occur. The mechanism of stress distribution and load transfer to the implant/bone interface is a critical issue
affecting the success rate of implants. Therefore, the aim of this study was to conduct a brief literature review of
the available stress analysis methods to study implant-supported prosthesis loading and to discuss their
contributions in the biomechanical evaluation of oral rehabilitation with implants. Several studies have used
experimental, analytical, and computational models by means of finite element models (FEM), photoelasticity,
strain gauges and associations of these methods to evaluate the biomechanical behavior of dental implants. The
FEM has been used to evaluate new components, configurations, materials, and shapes of implants. The
greatest advantage of the photoelastic method is the ability to visualize the stresses in complex structures, such
as oral structures, and to observe the stress patterns in the whole model, allowing the researcher to localize and
quantify the stress magnitude. Strain gauges can be used to assess in vivo and in vitro stress in prostheses,
implants, and teeth. Some authors use the strain gauge technique with photoelasticity or FEM techniques.
These methodologies can be widely applied in dentistry, mainly in the research field. Therefore, they can guide
further research and clinical studies by predicting some disadvantages and streamlining clinical time.

Key Words: stress analysis methods, finite element analysis, photoelasticity, strain gauge, implants

INTRODUCTION implants because their biomechanical behavior is

considerably different from that of natural teeth.

T
he introduction of osseointegrated im-
plants has provided a significant im- The implant/bone interface demonstrates much less
provement in the quality of life for resilience compared with that of the tooth/bone
countless edentulous patients by allow- interface.4–9 Although natural teeth move around
ing for the replacement of missing teeth 100 lm when loaded, the movement of dental
and restoration of chewing function.1–3 Despite this implants is limited to 10 lm.10,11 Therefore, the
success, however, clinical problems may occur with stress created during implant-supported prosthesis
insertion and masticatory function can be more
1 directly transmitted to the bone.10 The absence of
University Sagrado Coração USC – Bauru – SP, Brazil.
2
Department of Dental Materials and Prosthodontics, Araçatuba implant resilience necessitates higher precision in
School of Dentistry, São Paulo State University–UNESP, São the planning, treatment, and fabrication of implant-
Paulo, Brazil.
3
Postdoctoral Research, Araçatuba School of Dentistry, São borne dental appliances.12
Paulo State University–UNESP, São Paulo, Brazil.
4
It is known that the mechanisms of stress
Federal University of Alfenas – UNIFAL, Alfenas, Brazil.
* Corresponding author, e-mail: goiato@foa.unesp.br distribution and load transfer to the implant/bone
DOI: 10.1563/AAID-JOI-D-11-00066 interface are critical issues that can affect the

Journal of Oral Implantology 217

Stress Analysis Methods to Evaluate Biomechanics of Implants

TABLE 1
Use of the finite element method to evaluate the stress of oral rehabilitation with implants
Author Year Study Variable Conclusion
43
Sertgöz 1997 Three different types of occlusal material The optimal combination of materials was
(resin, composite resin, ceramic) and 4 found to be cobalt-chromium for the
types of framework materials (gold, framework and porcelain for the
silver-palladium, cobalt-chromium, and occlusal surface.
titanium) in mandibular prosthesis with
6 implants and bone tissue
Arataki et al34 1998 Number of implants (2 or 4), localization, Design to the fixture placed in a straight
structure length, presence of a distal line; a decrease in the maximum stress
segment, loading condition in value of the compact bone surrounding
mandibular fixed prosthesis. the fixture was recognized with a
decrease in the total interfixture
distance and an increase in the number
of placed fixtures
Menicucci39 1998 Mandibular overdenture attachment Resilient attachments allowed for an
Daas et al35 2008 system. increase of the mastication load
Tanino et al8 2007 transiting through denture bearing
surface.
Pietrabissa et al42 2000 Different types of framework adjustment Prosthesis misfit influenced the pattern
Kunavisarut et al37 2002 and magnitude of stress distribution in
Natali et al41 2006 the prosthesis, implant components,
and surrounding bone, and the
presence of the cantilever or greater
occlusal force amplified the effect of
misfit.
Akpinar et al33 2000 Occusal contact between implant and High compressive stresses may contribute
natural teeth to intrusion of the tooth
Nagassao et al40 2002 Maximum stress around implants in Location and intensity of the stresses
patients with partial mandible resection occurring around fixtures differs
due to cancer significantly between various types of
mandibular reconstruction
Akça et al47 2002 Insertion of a shorter implant in place of a Significant lower stress values were
cantilever extension on stress recorded at the shorter implant
distribution compared with cantilevered placement configurations tHAN the
fixed prosthesis in posterior mandibular cantilevered prosthesis. Posterior
edentulism. cantilever extension performed higher
stress values than the anterior
counterpart
Lang et al38 2003 Preload of implant system A preload of 75% of the yield strength of
the abutment screw was not
established using the recommended
tightening torques.
Tada45 2003 Implant design and bone type Cancellous bone of higher rather than
lower density might ensure a better
biomechanical environment for implants
Geng et al46 2004 Conical implant screw design Minimal support constraints allow clearer
differentiation of the stress picture
between the different stepped screw
types at the trabecular bone-implant
interface
Sevimay et al48 2005 Four types of mandibular bone quality Simulating different bone qualities for an
implant-supported crown affected stress
distribution and stress values

218 Vol. XL /No. Two /2014

 Pesqueira et al

TABLE 1
Continued
Author Year Study Variable Conclusion
36
Kitamura et al 2005 Bone resorption Bone stress distributions were similar in
the nonresorption and horizontal
resorption models but differed from
those in the angular defect models; the
changes of the bone stress values with
resorption depth differed for the 2
resorption types
Simsek et al44 2006 Three different interimplant distances The magnitude of the stress was
influenced by complex factors such as
the direction of loads and the distance
between adjacent fixtures; the stress
occurring around fixtures differed
significantly with various types of
interimplant distance
Yang and Xiang31 2007 Implant composed of bioceramic and The study highlighted the influence of the
biometal material properties, volume fraction
index, occlusal force orientation, and
osseointegration quality on the
maximum von Mises stress, deformation
distribution, natural frequencies, and
harmonic response.
Falcón-Antenucci et al49 2010 Relationship between cusp inclination and Stresses on the implant and implant/
stress distribution in bone, implant, and abutment interface increased with
crown increasing cusp inclination, and stresses
on the cortical bone decreased with
increasing cusp inclination.
Manda et al50 2011 Study stress field development in distal The type of restoration appears to have a
abutments in two types of fixed dental much more serious impact on the stress
prostheses with different pulp cavity pattern developed in the distal
conditions abutment, and the addition of a
cantilever appears to biomechanically
compromise both biologic and
restorative structures

success rate of implants. Overload can lead to
mechanical complications and bone loss.10 In
addition, implant-supported prostheses present a
better biomechanical behavior when no excessive
occlusal force is transmitted.6
Therefore, it is essential to understand and
improve the load distribution from the prosthesis
to the implants and bone.4,10 During the past three
decades, researchers in this area have emphasized
the importance of the biomechanical aspect of
implant treatments, and they have sought to define
the limit of force transmission to the implants and
to develop methods to evaluate the biomechanics
of dental implants.7
Direct clinical evaluation (immediate or longitu-
dinal) would be the surest method to analyze the
biomechanical response of implant treatment.
However, the complexity of the structures involved
makes direct clinical evaluation of the biomechan-
ical behavior of intraosseous structures nearly
impossible, considering the difficulty of the meth-
odology, the potential ethical issues, and the long
period of time that would be required for this type
of study.2,5
To overcome these limitations, several studies
have used computational, analytical, and experi-
mental models by means of finite element analysis,
photoelasticity, and strain gauges to evaluate the
biomechanics of dental implants.4,13–19 In order to
reduce the limitations and determine the advan-
tages of each of these methods, several studies20–30
have used a combination of these methods as they
have been shown to be complementary. The aim of
the present study was to conduct a literature review
of the stress analysis methods used to investigate
the biomechanical behavior of implant-supported

Journal of Oral Implantology 219

Stress Analysis Methods to Evaluate Biomechanics of Implants
FIGURE 1. Stress distribution in axial load by photoelastic
analysis.
prosthesis and to discuss their contributions in the
biomechanical evaluation of oral rehabilitation with
implants.
FINITE ELEMENT METHOD
The finite element method (FEM) was developed in
the early 1960s by the aerospace industry, and its
use has spread.31 In 1976, Weinstein et al32 were the
first researchers to use the FEM in the implantology
field. Since then, several studies have used this
method to evaluate new components, configura-
tions, materials, and shapes of implants.31,33–45
The FEM uses virtual models to simulate and test
the progressive resistance and stress distribution of
complex estructures. According to FEM studies,31,33–45
this method enables the investigation of mechanical
problems, dividing the element-problem into many
smaller and simpler elements to create a mesh of
elements and to solve the problem by using
mathematical functions. Thus, it is possible to simulate
and evaluate the biomechanical behavior of bone,
220 Vol. XL /No. Two /2014
implants, and prosthetic components interfaces,
which would be impossible to analyze experimentally
in vitro or in vivo.2,3,14,41,46,47 The FEM enables
researchers to apply different loadings and to obtain
the displacement and the stress levels this load causes
on the tooth, prosthesis, implant, and bone.2,3,14,46,47
The mechanical modeling of the structures can
be performed in 2 or 3 dimensions. The 3-
dimensional analysis allows for the development
of models that are more true to real life and have
complex geometry, thereby creating more consis-
tent results.14,31,33,35,38,43
However, the FEM has some disadvantages and
criticisms. An important issue is the creation of very
complex models. Some simplifications and assump-
tions must be made to make the solution possible,
which affects the final result. Some simplifications
and assumptions usually adopted in studies of
dental implants are simplification of the geometry
of bone or implant system assuming that the bone
is homogeneous and isotropic, boundary condi-
tions, inconsistent type of bone-implant interface,
etc.3,14,35,38
The FEM has been widely used in dental
implantology as described in Table 1.
PHOTOELASTICITY
The photoelastic analysis was introduced in den-
tistry by Noona in 1949.48 Since then, this method
has been widely used in restorative dentistry.48 In
the implantology field, photoelasticity was first used
by Haraldson51 in 1980 to assess the quality of
fringes at different levels of implant insertion.
The photoelastic analysis technique is based on
the optical property of certain colorless plastic
materials that, when subjected to stress/deforma-
tion, present alterations on the refraction indices (or
optical anisotropy) promoting color change.52–54
The greatest advantage of the photoelastic
method is the ability to visualize the stresses in
complex structures, such as oral structures, and to
observe the stress patterns in the whole model,
allowing the researcher to localize and quantify the
stress magnitude.1,2,8,15,18,52–,55
Experimental tests using the photoelasticity
technique have been applied in several studies
involving an implant-supported prosthe-
sis2,13,15,18,51,55–61 to evaluate stress distribution. This
method allows for the qualitative analysis of stress

Use of the photoelastic method to evaluate the stress of oral rehabilitation with implants
Author
56
Helldén and Derand
Kenney and Richards57
Sadoswsky and Caputo58
Sadoswsky and Caputo59
Celik et al13
Ochiai et al60
Ueda et al.9
Markarian et al.61
Barbosa et al.55
Goiato et al2
Bernardes et al1
da Silva et al62
Pellizzer et al63
through the observation of optical effects in the
photoelastic models.52,54 Stresses inside the models
can be measured and photographed, whereas in
other analytical methods, graphs and diagrams of
stress distribution must be constructed from numeric
Pesqueira et al
TABLE 2
Year Study Variable Conclusion
1998 Fit and misfit framework The method appears to be an efficient
and accurate procedure for correcting
distortion in cast titanium frameworks.
1998 Overdenture attachment system For vertical and inclined implant designs,
2000 the lowest stress was transferred to all
2004 implants with the bar-ball attachment
2007 system; moderate stresses were
observed in implants on the loaded
side with unsplinted attachment
systems. The highest stress level
observed with all attachment systems
was moderate.
2003 Implants placed in the posterior Stress distribution and intensity for the 2
edentulous jaw fabricated with implant conditions was similar for
photoelastic material segmented and nonsegmented
abutment designs; magnitude of
stresses observed for both abutment
designs was similar for the single
implant condition.
2004 Parallel and tilted implants Stresses were generated after screw
2007 tightening of the frameworks,
increasing when a load was applied and
when a vertical gap was present.
2008 Size and location of misfit at implant- Great vertical misfits do not necessarily
abutment interface result in higher detorque values.
2009 Attachment systems of facial prosthesis The retention systems produced different
stress distribution characteristics that, in
general, were concentrated in the area
around the implants; the highest
concentration of fringes, in increasing
order, occurred in the retention systems
of the magnets, O-ring, and bar-clip.
2009 Connection system of cylindrical implant Under an off-center load, the internal-hex
interfaces presented the lowest stress
concentrations; internal-taper interfaces
presented intermediate results, and
one-piece and external-hex implants
resulted in high stress levels.
2009 Different types of connectors in implant- The internal hexagon implant established
tooth union a greater depth of hexagon retention
and an increase in the level of denture
stability compared with the implant
with the external hexagon. However,
this greater stability of the internal
hexagon generated greater stresses in
the abutment structures
2010 Influence of platform switching on stress Stress concentrations decreased in the
distribution in implants cervical region of platform switching,
and conventional/wide-diameter
displayed similar stress magnitudes
data.1,2,8,15,18,52–55 The photographic records are
qualitatively analyzed to investigate the propagation
and intensity of stress. Most of the stress evaluations
are performed visually. In 1995, Mahler and Peyton,54
described the sequence of fringes based on the
Journal of Oral Implantology 221
Stress Analysis Methods to Evaluate Biomechanics of Implants

TABLE 3
Use of strain gauge method to evaluate the stress of oral rehabilitation with implants
Author Year Study Variable Conclusion
68
Glantz et al 1993 Masticatory effort on full-arch fixed The results show fundamental differences
prosthesis under clinical and laboratory between in vitro and in vivo testing
simulations conditions. An unexpectedly high
bending of the implants was recorded
in many of the in vivo loading
situations.
Wang et al71 1995 Tensile strength and elongation of joining Microhardness values increased in the
titanium materials with tungsten inert heat-affected zone for all the specimens
gas welding, laser welding, and infrared tested.
brazing.
Duyck et al69 2000 Veneering materials on in vivo implants The clinical significance of the study was
the identification of an increased risk
for bending overload of the implants
that are closest to the point of load
application only in the case of acrylic
resin long-span prostheses or acrylic
resin prostheses with extensions.
Watanabe et al11 2000 Different types of screwed fixed The magnitude of strain produced around
prostheses with different sequences of a screw-retained implant prosthesis was
screw tighting significantly lower with the passive-fit
method compared with the other 3
fabricating methods.
Bassit et al64 2002 Load distribution on resin and ceramic There is a difference in resilience between
crowns acrylic resin and ceramic veneering
materials, but this difference is only
measurable in vitro, where the force is
generated by a shock only and the
implant is rigidly anchored,
Heckmann et al65 2004 Effect of impression technique, fabrication Bonding bridge frames onto gold
process, and attachment system of cylinders directly on the implants
implant-supported prosthesis significantly reduces strain
development,
Naconecy et al17 2004 Deformation of a metallic framework The direct splinted technique was the
connected to 15 stone casts fabricated most accurate transfer method for
using 3 transfer techniques multiple abutments compared with
direct nonsplinted and indirect.
techniques
Cehreli et al67 2005 Comparison of ex vivo bone tissue strains Although one prosthetic design did not
around natural teeth with immediate seem to have clear advantages over
implants supporting unsplinted and another, splinting of implants may be
splinted fixed prostheses considered a safety measure for
immediately loaded immediate
implants, if possible.
Karl et al66 2006 Screwed- and cemented- fixed prosthesis The level of precision of fit that can be
obtained in superstructure fabrication
would appear sufficient to produce
restorations that do not cause bone
damage.
Hegde et al73 2009 Evaluate the response of strain gauges to Strain in the bar increased significantly
known amounts of misfit in an implant with increasing levels of misfit.
bar
Karl et al74 2009 Create a methodology that can be used The present methodology can be applied
to study the effects of prosthesis misfit to study changes in static implant
in humans loading over time in humans

222 Vol. XL /No. Two /2014

 Pesqueira et al

TABLE 3
Continued
Author Year Study Variable Conclusion
75
Nishioka et al 2009 Quantify the strain development of The hexagon internal connection
external hexagon and internal hexagon displayed higher values of microstrain
implant-supported partial prostheses in than the hexagon external type implant
straight and offset implant placement placemen
configurations.
Nishioka et al76 2011 Analyze strain distributions caused by There was no evidence that there was any
varying the external and internal advantage to offset implant placement
hexagon, Morse taper, and influence of in reducing the strain around implants;
straight and offset implant the study revealed that the internal
configuration. hexagon and Morse taper joints did not
reduce the microstrain around implants.
Rungsiyakull et al77 2011 Effect of occlusal design on the strain A reduced cusp inclination and occlusal
developed in simulated bone of table dimension effectively reduced
implant-supported single crown models experimental bone strain on implant-
supported single crowns; the occlusal
table dimension appeared to have a
relatively more important role than cusp
inclination.
8
Yang et al. 2011 Biomechanical performance of short The splinting of two short implants had
implants in splinted restorations the same biomechanical effectiveness as
splinting with a single long implant.
Nissan et al79 2011 Transfer of axial and nonaxial load in Crown height space is more significant
unsplinted fixed implant supported than crown to implant ratio in assessing
restoration with varying crown to biomechanical-related detrimental
implant ratios and crown height space effects. Prosthetic failure occurred at
crown height space 15 mm.

FIGURE 2. The maximum equivalent Von Mises stress on the implant.

Journal of Oral Implantology 223

Stress Analysis Methods to Evaluate Biomechanics of Implants

TABLE 4
Use of association of stress methods to evaluate the stress of oral rehabilitation with implants*
Author Year Method Study Variable Conclusion
24
Clelland et al 1995 Strain gauge and Different misfit in Strains were transferred to the bone
photoelasticity overdenture when misfitting prostheses were
secured.
Brosh et al22 1998 Strain gauge and Straight and tilted implants Data obtained from strain gauges
photoelasticity bonded to implants embedded in a
medium can represent a precise
simulation of the clinical condition
when analyzing stress distribution
along the implant/ bone interface.
Photoelasticity provides different
information and therefore should be
regarded as a complementary
method.
Kim et al29 1999 Strain gauge and Prosthesis retained by In 2-implant supported distal
photoelasticity temporary luting agent, cantilevered prostheses, the screw-
permanent luting agent, type and the permanent-cement-
and screwed retained prostheses developed more
stress around the apex of both
implants. The permanent-cement-
retained prostheses acted almost the
same as the screw type.
Akça et al20 2002 Strain gauge and FEM Dental implants submitted to There is compatibility between
Iplikçioglu et al27 2003 vertical and oblique forces nonlinear finite element stress
analysis and in vitro strain gauge
analysis on the measurement of
strains under vertical loading.
However, there are differences
between the methods in
quantification of strains on the collar
of implants under lateral loading.
Fernandes et al26 2003 Strain gauge and Effectiveness of reflective Reflective photoelasticity is a valid,
photoelasticity photoelasticity as a reliable, and accurate technique that
technique for in vivo may be used for in vivo studies on
monitoring the biomechanical behavior of
prosthetic devices.
Çehreli et al23 2004 Strain gauge and Different types of implant/ Butt-joint and internal-cone oral
photoelasticity abutment systems implants have similar force
distribution characteristics. The
implant-abutment mating design is
not a decisive factor affecting stress
and strain magnitudes in a bone
simulant.
Karl et al28 2006 Strain gauge and FEM Passivity in screwed and The level of precision of fit that can be
cemented fixed prostheses obtained in superstructure
fabrication would appear sufficient
to produce restorations that do not
cause bone damage.
Ozçelik et al and Ersoy30 2007 Photoelasticity and Tooth/implant-supported If tooth and implant abutments are to
FEM fixed prostheses with rigid be used together as fixed prostheses
and nonrigid connectors supports, nonrigid connectors
should be placed on the implant
abutment-supported site.
Akça and Çehreli21 2008 Photoelasticity and Different types of conical To reduce stresses in the peri-implant
FEM implants region, implant diameter may be
more effective than type of implant.

224 Vol. XL /No. Two /2014


Author Year Method
72
Eser et al. 2009 Strain gauge and FEM
* FEM indicates finite element model.
values of fringe order (N) N: 0 (black), 1 (transition of
red/blue), 2 (transition of red/green),3 (transition of
pink/green)* as reference for comparisons between
samples in vitro. The higher the N (fringe order) and
fringes number are, the greater the stress intensity.
And the closer the fingers are, the higher the stress
concentration (Figure 1).*
According to Goiato et al15 3 techniques of
photoelasticity are available: 2-dimensional, 3-di-
mensional, and quasi-3-dimensional (the model is 3-
dimensional but the fringes are observed and
analyzed in 2 dimensions). In addition, the reflection
photoelasticity technique has been described.26
In 2003, Fernandes et al26 showed the effective-
ness of reflective photoelasticity as a quantitative
technique, and similar stress values were noted
when compared with the strain gauge technique.
Thus, the authors considered reflective photoelas-
ticity to be a valid, applicable, and necessary
method to evaluate the biomechanical behavior of
in vivo structures. However, this technique has had
been limited study, so further studies are warranted.
Photoelasticity also presents some limitations.
Because it is an indirect technique, it requires similar
patterns of reproduction to be compared with
clinical situations. Another factor to consider is the
limit of applied external force, which may not
exceed the limit of resistance of the photoelastic
material; this could alter the outcome or promote
material rupture.23,60,62 Although the resin used to
fabricate the experimental models has an elasticity
modulus similar to bone tissue, no differentiation
between cortical and trabecular bones is possible,
* References 2, 13, 15, 18, 51, 54, 55, 57, 60, 61.
Pesqueira et al
TABLE 4
Continued
Study Variable Conclusion
Evaluate the level of Considering the complex
agreement between biomechanical behavior of human
nonlinear finite element hard and soft tissues, ex vivo strain
stress analysis and ex vivo gauge analysis and nonlinear finite
strain gauge analysis on element stress analysis did not
immediately loaded suggest inconsistency in the
implants detection of the quality of strains.
Further, the methods provided
comparable values for the
quantification of strains on implants
supporting maxillary overdentures.
which alters the magnitude of stress induced by the
load. However, not only the stress location but also
the stress behavior are similar to those observed
clinically.60,62
Currently, photoelasticity has been used to
evaluate stress in implant-supported prosthesis
and bone tissue in several studies that simulate
the mechanical-clinical situations presented in this
type of rehabilitation, as shown in Table 2.
STRAIN GAUGES
Strain gauges are small electric resistors that under
slight deformation alter the resistance created in
their current.11,64,65,66 They measure the deforma-
tion of an object where they are applied. The
captured electrical signal is sent to a data acquisi-
tion board, turned into a digital signal, and read by
the computer. The gauges are able to precisely
record the deformation of any object subjected to
stress.15,17,67,68 Strain gauges can be used to assess
stress in prostheses, implants, and teeth both in
vivo and in vitro.68–71 Methods based on strain
gauges have been used to calculate rather than
measure tissue stress and strain.1 The use of a strain
gauge to evaluate the stresses induced in the
implants presents clinical reliability.11,17,64–68 In
numeric analysis, several assumption are necessary
to represent the physical problem into a mathe-
matical model, and this accuracy should be
checked.72 Some authors use the strain gauge
technique along with either the photoelasticity
technique22,24,26,29 or the FEM.25,27,28
However, there is no conclusive information
about the ideal model to perform this type of study.
Journal of Oral Implantology 225
Stress Analysis Methods to Evaluate Biomechanics of Implants
Some claimed to place the strain gauges directly on
prosthetic pieces,17,66 while others indicated that
they placed the gauges on similar bone materi-
al.31,65,67 Strain gauges have been used extensively
on bone in vivo or ex vivo and even in coagulum
around immediate implants, but the measurements
are limited to the area where the gauge is bonded
or embedded.70,72
The use of strain gauge to evaluate stresses
induced on the implants is reliable, as observed in
the literature (Table 3).
DISCUSSION
Laboratory and clinical research has shown that the
clinical success and the longevity of dental implants
can be controlled by biomechanical factors in most
cases. Also, the load should be transmitted to the
bone in a manner similar to the physiological
way.1–10,12 Furthermore, changes in the magnitude
and distribution of load can affect the quality and
quantity of stress in a prosthesis/implant/bone
system.4,6,10
The biomechanical mechanisms related to im-
plant failure remains unknown. Bone resorption,
fracture, and loss of implant linked to biomechan-
ical factors are inconclusive.4,6,7,13,23 Understanding
these factors is necessary for the development and
mastery of new techniques and protocols to treat
edentulous patients.17,58,59
The stress analysis as photoelastic resin model
and 2- and 3-dimensional FEM are limited to a
single structure. Some authors consider those
methods unreliable,67,70 as they do not allow the
quantification of stress. Methodologies that enable
the analysis of stress generated directly on the
implant-retained systems via elastic deformation,
such as strain gauges, have been broadcast.4,13–19,60
However, when complex geometry is involved in
the analysis, it is difficult to determine the analytical
solution; therefore, the FEM, by using numeric
procedures, helps to solve this problem in order
to understand the mechanical behavior and calcu-
late the stress.3,14,46
According to these studies,2,3,14,31,33–47 by un-
derstanding the basic theory, method, application,
and limitations of the FEM, clinicians can interpret
the results of this methodology and extrapolate the
results to clinical situations. In the FEM, von Mises
stress distribution indicates that stress is great
226 Vol. XL /No. Two /2014
around the top of the implant, bone, and prosthetic
structure with different intensities in different
loading cases,80 as illustrated in Figure 2.
Similar to the FEM, photoelasticity can be
evaluated in 2 or 3 dimensions. Additionally, both
techniques require similar patterns of reproduction
in order to be compared with clinical situations.
On the other hand, strain gauge analysis can be
used to assess stress in prostheses, implants, and
teeth both in vivo and in vitro.68–71 The Reflective
photoelasticity can also be used in vivo.
Based on several studies20–30,72 no one method
can be classified as better than the others. Thus,
there is consensus among the researchers that all
methods are complementary, and this association
has been used as described in Table 4.
CONCLUSION
Numeric methods of stress analysis estimate stress
level with high accuracy in terms of intensity and
location. The FEM has been used to evaluate new
components, configurations, materials, and shapes
of implants. The greatest advantage of the photoe-
lastic method is the ability to visualize the stresses
in complex structures, such as oral structures, and
to observe the stress patterns in the whole model,
allowing the clinician to localize and quantify the
stress magnitude. Strain gauges can be used to
assess stress in prostheses, implants, and teeth both
in vivo and in vitro. Some authors use the strain
gauge technique accompanied by either the photo-
elasticity technique or the FEM.
These methodologies can be widely applied in
dentistry, mainly in the research field. Therefore,
they can guide further research and clinical studies
by predicting some disadvantages and streamlining
clinical time.
ABBREVIATION
FEM: finite element model
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