Three-dimensional Stress Distribution Around a Dental Implant at Different Stages

of Interface Development
L. BORCHERS and P. REICHART
Zentrum Zahn-, Mund-, und Kieferheilkunde der Medizinischen Hochschule Hannover, Karl-Wiechert-Allee 9, D-3000 Hannover 61, Federal
Republic of Germany
An anchor-type ceramic dental implant contained in a section of the
mandibular molar region was modeled for finite element stress
analysis. The distributions of stresses in the bone around the
implant due to axial and transverse loading were calculated for
different stages of normal and pathological development of the
implant-bone interface. Highest stress concentrations are observed in
the crestal region with transverse loading when spongy bone sur-
rounds the implant immediately after surgery. Development of a
lamina dura around the implant slightly reduces severe stress peaks,
whereas ingrowth of connective tissue almost eliminates them.
J Dent Res 62(2):155-159, February 1983
Introduction.
Anchor-type endosteal implants made of aluminum oxide
ceramic (Al203-ceramic) were used to replace teeth in the
molar region of the mandible.1 The occasional clinical and
experimental failures of this type of implant were partly due
to connective tissue formation at the implant-bone inter-
face2-3 and showed the need for a detailed stress analysis.
Since the finite element method (FEM) has proved to be a
useful tool in estimating stresses around implants of
different designs,46 this method was adopted to analyze
a loaded implant in situ. The objective of the present in-
vestigation was to simulate different stages of normal and
pathological interface development, and to calculate stress
distributions in the bone surrounding the implant. Results
from such a study will improve the understanding of the
mechanisms of tissue reaction and failure in endosteal
dental implantation.
mandibular section has been regarded as symmetrical to the
plane in Fig. 1, which allowed modeling of only one of the
symmetrical halves, with the other half simulated by appro-
priate boundary conditions. The slight curvature of the
mandible in the anterior-posterior direction has been
neglected for ease of modeling.
Four possible stages of implant-bone interface develop-
ment (Fig. 3) were simulated in the model by varying
input data for the mechanical properties of the layers in the
interface region shown in Fig. 2b. In Fig. 3, model con-
figuration A represents the situation immediately after
implantation, when the implant is totally surrounded by
cancellous bone. Brinkmann2 observed development of a
cortical bone-like lamina dura around the implant in about
50% of all cases of successful implantation. This situation is
represented by configuration B. Proliferation of connective
tissue into the gap between implant and spongy bone,
increasing implant mobility and causing subsequent
failure,3'9 is reflected in configuration C. Finally, it might
happen that, after successful implantation and formation of
a lamina dura, connective tissue migrates along the implant
stem as represented by configuration D.
ling

Materials and methods.

For this study, an anchor-type endosteal implant,
which was made of Al203-ceramic, was chosen. The crown
of the implant is at an angle of 150 to the stem's axis to allow
for the run of the inferior alveolar nerve (Figs. 1 and 2a).
A section of the molar region of the mandible, 50 mm in
length and containing the implant, was modeled for stress
analysis by means of the FEM.7 The Structural Analysis
Program, SAP IV, was chosen for the computations. This
program requires that a three-dimensional structure be
divided into hexahedral elements; adjacent elements are
connected to each other at their common corners or
nodes. Each element is defined by eight such nodes.8
The mandibular region to be analyzed is represented
by its cross-section in Fig. 1. The whole structure was
divided into a series of horizontal, vertical, and inclined
sections, which, in turn, were subdivided into quadrangles
in such a way that a three-dimensional network formed by
hexahedrons developed. The finite element models of the
implant and layers of surrounding tissues are shown in the
series of computer-drawn Figs. 2a-d. In total, the model 2mm
_-~
consists of 1129 elements, with 1473 nodes. The
Fig. 1 - Buccolingual section through mandible in the region of
the first molar with implant in situ (buc: buccal side, ling: lingual
Received for publication January 19, 1982 side). The 15° angle between crown and shaft of the implant allows
Accepted for publication August 12, 1982 for the run of the inferior alveolar nerve.
155
156 BORCHERS & REICHART J Dent Res February 1 983

In the model, the tissues and ceramic were regarded as
homogeneous, isotropic, and linearly elastic materials. Their
mechanical properties listed in the Table were selected from
the literature. No slip between the implant and surrounding
tissue was allowed to occur in the model.
Two load cases were taken into account for each of the
four model configurations. A force of 200 N was chosen to
act: first, occlusally, i.e., parallel to the axis of the
implant's crown; and second, in the lingual direction,
perpendicular to the crown's axis. For convenient com-
parison of the results, and due to lack of data in the litera-
ture, the forces were taken as equal in both cases, even
though the lateral forces are most probably smaller in
reality. Force was applied at the top center node of the
implant crown. The reaction force was generated by con-
straining the bottom nodes of the model.

B
2 mm

j,i

C D
Fig. 2 - 3-D view of finite element model parts, seen from the lingual side (only one of the symmetrical halves shown). In the appropriate
scale, the model parts fit into each other: the implant wing and stem into the cavity of the surrounding layers, and those parts into the hollowed-
out spongy bone, etc.
(a) Model of implant.
(b) Model of two tissue layers surrounding the implant. Thickness of the layers is 0.4 mm and 0.8 mm, respectively.
(c) Model of spongy bone around two layers of Fig. 2b.
(d) Model of enclosing cortical bone layer.
In b-d, the lingual portions facing the viewer have been removed for clarity.
Vol. 62 No. 2 STRESS DISTRIBUTIONAROUND A DENTAL IMPLANT 157

buccal the lingual portion exhibits stress distributions similar to

side
CONFIGURATION A CONFIGURATION B CONFIGURATION C
_ A1203-ceramic spongy bone
cortical bone/ lamina dura = connective
Fig. 3 - Illustration of different possible stages of interface
development around the implant in the buccolingual section.
Results.
The computations resulted in values of a stress tensor for
each element of the model. For clarity, only distributions
of maximum and minimum principal stresses are presented.
These may be regarded as the maximum and minimum
stresses acting at a given point in any direction. A positive
sign indicates tensile stress; a negative sign indicates com-
pressive stress.
In Figs. 4 and 5, the principal stresses vs. location are
plotted, as indicated by the bold lines around the implant
in the sketches. Fig. 4 applies to the bone layer directly
adjacent to the implant. Since stresses within the connec-
tive tissue are not of interest in this study, configurations
C and D do not appear in this Fig. They are, however,
included in Fig. 5, which refers to the model sheath of
bone being farther away from the implant surface.
Most evident in the buccolingual section for axial load
(Fig. 4a) are the strong compressive stress peaks near the
lingual upper portion of the implant stem for the cancellous
those obtained with axial loading. Remarkably, however,
stress levels are about five times as high as with the axial
load. Furthermore, tensile stress peaks of about 40 N/mm2
occur near the buccal part of the stem.
Since the longitudinal sections are symmetrical, only
half of the stress distributions are shown in Figs. 4c and 4d.
They are exceptionally smooth and of low magnitude
around the implant wing (note the enlarged scale). In the
protruding part of the stem, major stress concentrations
are compressive with axial loading, and they are both
compressive and tensile with transverse loading. These
CONFIGURATION D
stress peaks are less marked within the lamina dura (con-
figuration B), which is more rigid, and, hence, distributes
the load more evenly than does spongy bone (configura-
tissue
tion A).
The stress distributions in the outer portion of the two
model layers surrounding the implant are shown in Fig. 5.
The distribution for configurations A and B exhibits no
significant changes in shape with the increased distance
from the implant surface (compare Figs. 4a and 5a, 4b and
ib.ccal \ In aI 200\
"~'O
Ic \
WI
E-
E
-j
z
lc
iL

bone (configuration A) and the lamina dura (configuration

B) as well. In the latter, the stress level, in general, appears
to be slightly higher. Minor compressive stress peaks exist
LOCATION [mm]
under the lingual part of the stem's bottom in both cases. A B
With a transverse load of equal magnitude (Fig. 4b),

TABLE
MECHANICAL PROPERTIES ASSIGNED TO THE
DIFFERENT MATERIAL COMPOUNDS OF THE S r L i
FINITE ELEMENT MODEL 2

Elastic z2
I
Modulus Poisson's Reference L

Material N/mm2 Ratio Nos.

S
A120 3-ceramic 380,000
0.26 10
Cortical Bone 13,7000.30 4,6 0
Lamina Dura 13,700
0.30 4,6#
Spongy Bone
Connective Tissue 2
1,370
0.30
0.45
4,6
4,11##
a.
t[/"- 5 10
LOCATION [mm]
!I
iS 20 25 30
5
10

LOCATION [mFAN
15 20 25 30

#The properties of the lamina dura consisting of dense bone were C D

assumed to be the same as those of cortical bone, Fig. 4- Principal stresses in alveolar bone vs. location (distance
##There is a wide range of values given in the literature for the elastic from implant surface, 0.2 mm).
modulus of connective tissue.4'6'11'13 The value chosen for this (a) Axial load, buccolingual section.
study is close to that determined for human periodontal ligament in (b) Transverse load, buccolingual section.
a rotation experiment with central incisors in vivo.11 Poisson's (c) Axial load, mesiodistal section.
ratio is taken from reference no. 4. (d) Transverse load, mesiodistal section.
 158 BORCHERS & REICHART
JDent Res February 1983
200C\
20b U,

tive tissue layered between the implant and bone, with

slightly elevated stress levels occurring in the other parts of
the distributions (configurations C and D).
4 .

Discussion.
CO#NFP K;RATX
N
Our results are in the same range as those of a similar
0
investigation by Cook et al.,5 and, qualitatively, they
12 compare closely to those obtained by Soltesz et al.12 in a
photo-elastic study of an implant of the same type under
2 CONFIGURATIN
load.
E
0
-
Consistently, the most prominent stress peaks occur in
the bone (either cancellous or compact) near the protruding
part of the stem. Maximum compressive stresses on the
-J CONFtURAUT NC C lingual side are about 10 N/mm2 with axial loading and
about 50 N/mm2 with transverse loading. These values
were probably underestimated, since slip might occur
11 between implant and tissue - contrary to the model's
0
assumptions -thus at the least reducing the amount of load
transmitted by shear and tension. For the same reason, the
0 5 10 1s 20 25 high tensile stresses of about 45 N/mm2, which resulted on
A LOCATION [Min
the buccal side from transverse loading, are unlikely to be
transmitted by the interface. However, even if it is assumed
that the transverse load of 200 N is too high by a factor of
two or three, the resulting compressive stresses in the
mandible are still locally approaching the upper limit of
temporarily-acting physiological stresses. This limit is
29.8
CORFIGURATIONA believed to be about 25 N/mm2 , as indicated by FEM
Q,4. =
z-==.- analysis of a loaded natural tooth.13 Hence, we conclude
- 2 from our results that bone resorption in the crestal region
1-1
around this type of implant might occur due to stress
2\
~~~~~CONFIGURATION a1 concentrations during transverse loading. In case of no
E
E
'O ~~~~~~~~~~~~ resorption, however, the observed stresses could be high
,E enough to prevent the bone from proper apposition to the
Zt
-2 §, implant, since they locally exceed the level of constant
A- US
2 ~ ~~~~~~
CONFlaURAr10iN C:
stress favorable to induced bone formation. This level has
I-
0. been determined, in a rabbit experiment,14 to be about 3-4
0
-2
N/mm2, and is thought to be of the same order of
COWFIGt)RAN 0 D magnitude for humans.
_2o/' o==A~~~~~~~~~1 A lamina dura commonly formed around the implant in
a clinically favorable course of healing tends to distribute
5 10 15 20 25 30 0 5 10
stresses more evenly than does spongy bone. The time
o 15 20 25 30
LOCATION Umm
*1D LOCATION (mm] immediately after insertion of the implant - while its
Fig. 5 Principal stresses in alveolar bone vs. location (distance
-
surroundings still consist of spongy bone and exhibit
the most distinct stress concentrations - is likely to be
from implant surface, 0.8 mm). most critical for the success of the implantation. The
(a) Axial load, buccolingual section.
(b) Transverse load, buccolingual section. formation of a lamina dura, however, might be interpreted
(c) Axial load, mesiodistal section. as an adaptation of the biological system to the acting
(d) Transverse load, mesiodistal section. loads. Since connective tissue ingrowth considerably
reduces critical stress peaks in the adjacent bone, this way
5b, 4c and 5c, 4d and 5d; note different scales). In general, seems to be the most effective and the ultimate means for
intermediate connective tissue layers cause considerably the body to respond to injuriously high stresses.
smoother stress distributions without critical concentra-
tions in the crestal region, as may be derived from compari-
son of the results for configurations A vs. C and B vs.
Conclusions.
D. In the case of an occlusally acting force, however (Figs. From the results of FEM stress analysis of an anchor
S a and 5c), compressive stresses are slightly increased type A1203-ceramic dental implant, the following conclu-
under the stem base. Load transmission via the wings to sions may be drawn:
the bone is also enhanced (Fig. 5c, configurations C and D), 1. High stress peaks which were calculated in the crestal
probably due to less stress taken by the soft surroundings region of the alveolar bone, especially with transverse
of the post than by the bone surrounding the implant in loading, might cause bone resorption, connective tissue
configurations A and B. ingrowth, and subsequent implant failure. Stress concen-
For the longitudinal section (Figs. Sc and Sd), the high trations were most distinct with the implant's surround-
stress concentrations which occur in the crestal region ings consisting of cancellous bone.
directly after implantation (configuration A) are markedly 2. Presence in the model of a lamina dura or a connective
diminished by the development of a lamina dura (configura- tissue layer around the implant was found to reduce
tion B). They are almost completely eliminated by connec- stress peaks.
Vol. 62 No. 2 STRESS DISTRIBUTION AROUND A DENTAL IMPLANT
3. Further analysis should be done to evaluate design
improvements in order to increase the share of load
transmitted by the implant wings, thus unburdening the
stem region.
Acknowledgments.
Calculations in this study were carried out with the
support of the Regional Computation Center for Lower
Saxony at the University of Hannover (RRZN). We wish to
thank Mrs. Katharina Schmidt for her help with the data
preparation and illustrations.
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