1 4972444231701364826

JOMI on CD-ROM, 1993 Jun (662-673 ): A Method of Selecting the Best Implant Prosth… Copyrights © 1997 Quint…
A Method of Selecting the Best Implant Prosthesis

Design Option Using Three-Dimensional Finite Element
Analysis
Martin Kregzde, MS, Dipl Ing, PE
This report presents a method for determining the optimum arrangement of

implants and the optimum scheme of prosthesis splinting using biomechanics
and three-dimensional finite element analysis. The three-dimensional finite
element structural analysis method was used to determine the distribution of
occlusal forces on teeth and dental implants. The results of the analysis showed
that force distribution on occlusal surfaces does not change significantly with
changes in the scheme of prosthesis splinting or implant positions. The induced
stresses in bone are sensitive to the scheme of prosthesis splinting and implant
positions. Induced stresses on implants for different schemes of prosthesis
splinting and different implant positions varied as much as 1,000%. Therefore,
the selection of implant positions and of the scheme of prosthesis splinting is
critical for the longevity and stability of an implant prosthesis. (INT J ORAL
M AXILLOFAC IMPLANTS 1993;8:662–673.)
Key words: finite element analysis, prosthesis design
Prior to the use of implants, fixed partial denture prosthesis design constraints were
known and the options were limited. With implant options now available, the
question arises, which prosthesis design is the correct one? Theoretically, there are
an infinite number of possible prosthesis design variations including combinations of
implant locations and schemes of prosthesis splinting. Stability and longevity of a
prosthesis are paramount in implant prosthodontics. Performance of an
implant-supported prosthesis depends on two factors: implant positions (to include
angulation) and the scheme of prosthesis splinting. Regardless of how good the
implant design and its surface interaction with bone, the importance of the scheme of
prosthesis splinting and implant positions cannot be overemphasized. A prosthesis
should be designed to avoid high stress concentrations in supporting bone. The ideal
solution is the original Creator's design concept of one implant for each missing
tooth root, but cost and bone volume could be limiting factors.
The analysis of occlusal force distribution on implants and the selection of an
optimum prosthesis design are not fully addressed in the current literature. The
models of Skalak,1 Brunski,2 and Mailath et al3 give clinicians factors operative in
implant loading, but not an actual method of analysis. The analysis of implant force
transmission to interfacial tissues and supporting bone has been investigated and
reported in the literature. Finite element studies have focused on the interaction of
single implants with supporting bone. Siegele and Soltesz4 studied stress distribution
at the bone interface of four different implant configurations. Rieger et al5,6 studied
the stress distribution of three and six different endosseous implants. Rieger et al7
also studied stress distribution of bone-adapted versus bone-bonded implants.
Rossen et al8 studied how stress-absorbing elements in freestanding implants and
implants connected to natural teeth affect stress distribution to supporting bone.
Clelland et al9 studied stress distribution to supporting bone with a three-dimensional
model of a single Screw-Vent (Dentsply Implant Division, Encino, CA) implant.
These studies agree that critical stresses in bone are concentrated at the neck and
apex, with less stress transfer along the middle portion of the implant. Present
research does not investigate sufficiently the determination of resultant loads on
implants caused by occlusal forces. Improper location of implants and an improper
scheme of prosthesis splinting can increase stress intensities in supporting bone.
High stress concentrations are a suspected etiologic factor in the loss of
osseointegration. Three-dimensional (3D) finite element analysis is an engineering
tool, widely applied in the aerospace industry, that can be used to solve complex
implant prosthesis problems.
Occlusal forces result in force and moment vectors on teeth and implants. The
purpose of dental implants is to transmit these forces to the supporting bone. The
main object of this study is how to minimize the stress concentration on the implants
and natural teeth. The purpose of this article is to describe the application of 3D
finite element analysis to determine occlusal forces and resultant stresses on
implants and supporting bone.
Materials and methods
The 3D finite element model analyzed here represents an actual patient's dentition,
but the model can be manipulated to represent any patient's dentition. The prostheses
were placed in the mandibular posterior quadrants (Figs 1 to 3). The prosthesis for
the left mandible was attached by fixation screws to two Integral (Calcitek,
Carlsbad, CA) implants via Universal Modification Abutments (UMA, Attachments
International, San Mateo, CA) and to a canine ceramometal crown with a tubelock
semiprecision attachment (Sterngold, San Mateo, California). Vague discomfort
during chewing led to a preliminary structural analysis before restoration of the right
mandibular quadrant. The prosthesis for the right mandible was also attached with
fixation screws to two Integral implants with UMAs, but by a solder joint to the
canine ceramometal abutment crown rather than by a tubelock attachment. The right
mandibular prosthesis was not associated with the same unusual or abnormal
sensation as the left mandibular prosthesis. After 1 year, a radiograph showed some
crestal bone resorption around the left distal implant (Fig 4). Three-dimensional
finite element analysis was applied to determine the relative resultant stress values
on the implants for different prosthesis designs. Ten different prosthesis designs for
the left mandible were evaluated (Figs 5a to 5i). Because the right mandibular
prosthesis was asymptomatic, the left mandibular prosthesis was reworked to

incorporate a solder joint to the natural canine abutment crown.
The 3D finite element model was developed to represent stiffness characteristics
of the skull and the prosthesis. Comparison of the relative stresses in the implants
between the different options could select the best prosthesis design candidate. The
structure analyzed (Figs 1, 2, 3, and 6) consisted of the mandible, maxillae, natural
teeth, implants, and a prosthesis. The structure of the cranium was omitted and its
presence was simulated by beam elements with estimated cranial stiffness. The
estimated cranial element stiffness was increased tenfold to evaluate its structural
importance and its sensitivity to the results of finite elements analysis. Two 3D finite
element analyses were performed chewing the same "food"; one with the estimated
cranial stiffness and the other with the tenfold increase. The observed changes in the
resultant forces between the two models were negligible. The reason for this
phenomenon is that the self-balancing muscular forces based on Saint Venant's
principle do not penetrate far enough into the cranium.
The jaws were subdivided into a finite number of discrete elements (Table 1),
which were connected at the corner points called nodes. Figure 6 shows the actual
3D finite element model configuration and overall description. The sum of all
elements formed the complete structure. Each node had a maximum of six degrees of
freedom; three translations (∆x, ∆y, and ∆z); and three rotations (Qx, Qy and Qz) (
Figure 3). One equilibrium equation existed at each node for each degree of freedom.
The total number of equilibrium equations equaled the number of nodes times the
degrees of freedom at each node. All equilibrium equations together formed the
stiffness matrix for the structure, which can be expressed in the following matrix
form: [K] {u} = {F}, where [K] = stiffness matrix, {u} = nodal deformation, and
{F} = applied nodal forces. The structure had n = 438 nodes and m = 2,300 degrees
of freedom, giving 2,300 equations that were solved simultaneously for unknown
deformations. From the obtained deformations, forces and stresses were calculated.
The unique solution should satisfy the equilibrium, deformation compatibility, and
boundary conditions of the structure.
The finite element program NASA Structural Analysis (NASTRAN)
(Computerized Structural Analysis and Research, Northridge, CA) was used to
analyze the occlusal and resultant implant forces. In the 3D finite element analysis
example, osseointegration was assumed for direct transfer of forces from the
implants to supporting bone without relative motion. The occlusal force distribution
mainly depended on the spring rate or stiffness of the food (K) and the elastic
properties of the mandible and maxillae. The iterative 3D finite element solution
determined the occlusal forces. The force distribution on the implant and supporting
bone could be manipulated by changing the scheme of prosthesis splinting and the
locations of the implants. The design process was iterative, ie, the 3D finite element
solutions were repeated for different implant locations and prosthesis designs until
minimum stress distributions at the bone-implant interface are obtained. Absolute

values of the calculated stresses were unimportant because the relative values
determine the merit of the different prosthesis designs tested.
Muscular forces that move the mandible vary in magnitude during the chewing
cycle. Therefore, the occlusal forces are time dependent and required dynamic
response analysis. D'Aiembert's dynamic equilibrium for the instant time slice was
used and applied to a linear static analysis. The applied muscular forces were
assumed to be linearly proportional to the deformation of the skull and were applied
to the structure gradually. The muscular forces were applied to the mandibular ramus
and angle, and were balanced-by forces of attachment to the maxillae. The skull
structure was in a self-equilibrating state and the 6 equilibrium equations of statics
are satisfied: ΣPx = 0, ΣPy = 0, ΣPz = 0, ΣMx = 0, ΣMy = 0, ΣMz= 0.
Kinematic constraints were provided to the structure to prevent rigid body
motions. The muscular forces were applied to the left and right sides of the jaw. The
resultant magnitude of muscular force (ΣF) was arbitrarily chosen to be 578 N per
side (Figs 7 to 9). The actual value of occlusal forces was not required for the
purpose of parametric studies, because the finite element analysis results of different
prosthesis options were to be compared to each other on the basis of relative stress
intensities. The results could be scaled up or down by the factor ΣF/578 N, where ΣF
is the different applied force. For simplicity, only axial occlusal forces were included
in the analysis. Horizontal components were neglected because the magnitude
compared to the axial forces was small.
Because of the presence of a periodontal ligament (PDL), the natural teeth are
more flexible than implants. To assess the effects of a PDL on occlusal and resultant
implant forces, prosthesis option 2 was modified with orthotropic plates under the
natural teeth. The orthotropic plates were used to approximate the PDL effects. The
natural-tooth root elements are imbedded into orthotropic plates with reduced elastic
properties along the long axis of the tooth root. The reduced plate stiffness is
supposed to approximate and simulate the PDL. The critical implant stresses were
calculated at the implant-bone interface. Increasing flexibilities in the orthotropic
plates (decreasing the E modulus) by more than 50% in the long axis of the tooth did
not change the occlusal and resultant implant forces appreciably. More detailed
evaluation of PDL effects are desirable.
The stiffness K of the chewing material ("food") is defined by the quotient K =
F/u (Fig 10). Four "foods" with varying stiffness values were subjected to occlusal
forces (Table 2).
The material properties used in the 3D finite element analysis are shown in
Table 3. Cortical and trabecular bone were not modeled separately. An intermediate
value to those used by Siegele and Soltesz4 was used for the modulus of elasticity of
bone. Finite element analysis assumes the following mechanical properties of the
materials comprising the structure.

1. Homogeneous. Mechanical properties of the material are the same throughout
each structural element.
2. Isotropic. The material properties are the same in all directions of the structural
element.
3. Linearly elastic. The deformations or strains of the structure are proportional to
the applied forces.
Results
The elastic properties of bone affect occlusal force distribution (Table 4) and
consequently the resultant forces on implants. Occlusal forces were distributed more
distally when the bone was softer (lower modulus of elasticity, ie, smaller E value).
Occlusal forces were more evenly distributed anteroposteriorly when the bone was
stiffer (higher modulus of elasticity, ie, larger E value).
Occlusal force distribution for different prosthesis configurations and different
"foods" is summarized in Table 5 and Figure 11. With increasing food resistance
(stiffness K) occlusal forces are increased distally (Fig 11). The occlusal force vector
magnitudes (F1 to F15) do not change significantly for different prosthesis designs
chewing the same food. Occlusal forces are reacted on the prosthesis abutments
(implants and natural teeth); those reactions are shown in Figure 12 and are
summarized as axial loads (R), horizontal loads (H), and bending moments (M) in
Tables 6 and 7. Chewing the softest food (175 N/mm) resulted in a large difference
between option 1, with a nonrigid connector to the canine, and option 2, with a rigid
connection (solder joint) to the canine. The axial force on the most distal implant
(implant 1) changed from +30.7 N (tension) for option 1 to –30.2 N (compression)
for option 2 (Table 6). The axial force on the mesial implant (implant 2) resulted in
an equally large change from –209.5 N for model 1 to –117.0 N for model 2 (Table 6
).
Option 4 incorporated an additional implant 3 mm distal to the natural canine; in
Figure 13 the stress distribution is compared graphically to that of option 1. Stresses
are summarized for all 10 options in Table 7. Occlusal force reactions in the
supporting bone at the implant connections changed substantially between different
prosthesis designs chewing the same food. The variation of resultant stress
magnitudes exceeded 1,000% (Table 7), and in some cases the stresses reversed sign
from compression (–) to tension (+). In the actual patient's case, to reduce the
potentially damaging high stresses associated with option 1, the prosthesis was
reworked and rigidly splinted to the natural canine, as in option 2.
Prosthesis options 1, 2, 3, 4, 6, and 7 have a tensile stress component on some of
the implants. The remaining prosthesis options (5, 8, 9, and 10) do not have any
tensile stress components at the bone-implant interface. Option 10 has the lowest
stresses overall, and therefore is the best selection of the prosthesis options (Table 7
and Fig 13).
Discussion
In evaluating the stresses associated with prosthesis options 1 through 10 (Figs 5a to
5i) at the bone crest implant interface (Table 7), it is most desirable to select the
option which has no tensile stress component. Tensile stresses at the bone-implant
interface produce peak cervical or neck stresses in the supporting bone. These
stresses are the product of excessive bending moments on the implant, and are
detrimental to stability of the implant. Since fatigue and fracture analysis depends on
the magnitude of the cyclic stress intensities in the supporting bone, selection of the
number and positions of implants and the scheme of prosthesis splinting are of
utmost importance to the longevity and stability of the prosthesis. To reduce the
damaging effect of bending moments on the implants, the flexibility and redundancy
of the prosthesis (scheme of splinting) should be optimized. A properly designed
prosthesis will minimize the moment M, vertical force V, and horizontal force H
components on implants, and consequently will reduce stresses in the supporting
bone.
Conclusions
Three-dimensional finite element analysis facilitates identification of the optimal
sites for implant placement, as well as of the optimal scheme of prostheses splinting.
The sample prostheses evaluated clearly indicate the importance of proper prosthesis
design to promote prosthesis longevity and stability. The selected goal is to obtain
minimum compressive stresses in the bone supporting the implants.
The prosthesis design method for selecting the most efficient and reliable
prosthesis presented here is based on rational iterative finite element solutions. The
automated finite element software could be used in the dental office. Simple
operational inputs on a personal computer would select the most efficient prosthesis
design of the options presented.
Acknowledgments
The author is grateful to Computerized Structural Analysis and Research
Corporation of Northridge, California for providing the NASTRAN software and for
the execution of the finite element analysis. Special thanks is extended to CSAR's
president, Dr R. Narayanaswami (Swami), and the director of software development,
Mr Joe Cole, for the opportunity to complete the finite element analysis and for their
assistance; to colleague Michael Moyer for assisting in the formulation of the finite
element model; and Dr Robert L. Simon for editorial and prosthodontic
contributions.
1. Skalal: R. Aspects of biomechanical considerations. In: Brånemark P-I, Zarb GA,

Albrektsson T (eds). Tissue-Integrated Prostheses: Osseointegration in Clinical
Dentistry. Chicago: Quintessence, 1985;117-128.
2. Brunski J. Forces on dental implants and interfacial stress transfer. In: Laney WR,
Tolman DE (eds). Tissue Integration in Oral, Orthopedic, and Maxillofacial
Reconstruction. Chicago: Quintessence, 1992:108-124.
3. Mailath G, et al. 3D finite elemente analyse der Biomechanik von rein
implantatgetragenen extension brucken. Z Zahnärztl Implantol 1991;7:205-211.
4. Siegele D, Soltész U. Numerical investigations of the influence of implant shape on
stress distribution in the jaw bone. Int J Oral Maxillofac Implants
1989;4:333-340.
5. Rieger MR, Fareed K, Adams WK, Tanquist RA. Bone stress distribution for three
endosseous implants. J Prosthet Dent 1989;61:223-228.
6. Rieger MR, Mayberry M, Brose MO. Finite element analysis of six endosseous
implants. J Prosthet Dent 1990;63:671-676.
7. Rieger MR, Adams WK, Kinzel GL, Brose MD. Finite element analysis of
bone-adapted and bone-bonded endosseous implants. J Prosthet Dent
1989;62:436-440.
8. van Rossen IP, Braak LH, de Putter C, de Groot K. Stress-absorbing elements in
dental implants. J Prosthet Dent 1990;64:198-205.
9. Clelland NL, Ismail YH, Zaki HS, Pipko D. Three-dimensional finite element stress
analysis in and around the Screw-Vent implant. Int J Oral Maxillofac Implants
1991;6:391-398.
Fig. 1 Finite element model location

in the skull.
Fig. 2 Finite element model of

maxilla and mandible.
Fig. 3 Anterior view of finite element

model.
Fig. 4 Left mandibular prosthesis.

Fig. 5a Option 1 (patient's prosthesis):

The cantilever end is displaced less than 0.10 mm.
Figs 5a to 5i Finite element model, left mandibular configurations.
Fig. 5b Option 2: Prosthesis is soldered

to the naturaI canine abutment. Option 3: Prosthesis is attached to the natural canine
abutment and can transfer vertical and horizontal forces only.
Fig. 5c Option 4: A third implant has

been added immediately distal to the canine.
Fig. 5d Option 5: Prosthesis is

supported at each end and not in between.
Fig. 5e Option 6: Four implants rigidly

connected.
Fig. 5f Option 7: Same as option 6

except prosthesis is split in two pairs which are rigidly connected.
Fig. 5g Option 8: Four implant rigidly

connected.
Fig. 5h Option 9: Same as option 8

except prosthesis is split into two pairs which are each rigidly connected.
Fig. 5i Option 10: Same as option 8

except two implants are connected rigidly and two implants are freestanding.
Fig. 6 Overall description of 3D finite

element model: nodes = 438; quadrilateral plates = 333; triangular plates = 31; bending
beams = 42; axial rods = 20; spring constants (K) (represent the food between the teeth)
= 32; a = 51 mm; b = 51 mm; h = 27- to 31-mm mandible height; t = 6- to 13-mm
thickness; r = 15 mm radius of curvature; I = 92 mm.
Fig. 7 Muscle force: ΣF = 578 N.

Fig. 8 Mandible equilibrium forces.
Fig. 9 Applied loading: ΣF = ΣR = 587

N.
Fig. 10 Stiffness K;
Fig. 11
Occlusal force distribution (left mandible).
Fig. 12
Resultant forces on abutments (left side). Positive R valuff indicate tensile axial forces;
negative values indicate compressive axial forces. Positive H values indicate forces
acting to move the implant or tooth distally; negative values indicate forces acting to
move the implant or tooth mesially. Positive M values indicate moment forces acting to
rotate the implant or tooth clockwise and negative values indicate moment forces acting
to rotate the implant or tooth counterclockwise. All reactions as shown are positive and
acting on implants or tooth which are in bone. The out-of-plane reactions are negligible
and are not shown.
Fig.
13 Stress distribution on implants at the left mandible bone interface (stresses in MPa,
K 2 = 876).

1 4972444231701364826

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

1 4972444231701364826

Încărcat de

Drepturi de autor:

Formate disponibile

JOMI on CD-ROM, 1993 Jun (662-673 ): A Method of Selecting the Best Implant Prosth… Copyrights © 1997 Quint…

A Method of Selecting the Best Implant Prosthesis

This report presents a method for determining the optimum arrangement of

prosthesis was asymptomatic, the left mandibular prosthesis was reworked to

minimum stress distributions at the bone-implant interface are obtained. Absolute

materials comprising the structure.

1. Skalal: R. Aspects of biomechanical considerations. In: Brånemark P-I, Zarb GA,

Fig. 1 Finite element model location

Fig. 2 Finite element model of

Fig. 3 Anterior view of finite element

Fig. 4 Left mandibular prosthesis.

Fig. 5a Option 1 (patient's prosthesis):

Fig. 5b Option 2: Prosthesis is soldered

Fig. 5c Option 4: A third implant has

Figs 5a to 5i Finite element model, left mandibular configurations.

Fig. 5d Option 5: Prosthesis is

Fig. 5e Option 6: Four implants rigidly

Fig. 5f Option 7: Same as option 6

Figs 5a to 5i Finite element model, left mandibular configurations.

Fig. 5g Option 8: Four implant rigidly

Fig. 5h Option 9: Same as option 8

Fig. 5i Option 10: Same as option 8

Figs 5a to 5i Finite element model, left mandibular configurations.

Fig. 6 Overall description of 3D finite

Fig. 7 Muscle force: ΣF = 578 N.

Fig. 8 Mandible equilibrium forces.

Fig. 9 Applied loading: ΣF = ΣR = 587

Occlusal force distribution (left mandible).

S-ar putea să vă placă și