Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant–Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. 3D Model Design
2.2. Material Properties
2.3. Elements and Nodes
2.4. Interface Conditions
2.5. Loading and Boundary Conditions
2.6. FEA
3. Results
3.1. Overall Stress Distribution Pattern of Each Implant Assembly Component with Bone Loss Progression
3.2. Stress Distribution Pattern of Each ST Model Component with Different Bone Loss Levels
3.3. Stress Distribution Pattern of Each CT Model Component with Different Bone Loss Levels
3.4. Stress Distribution Pattern of Each SZ Model Component with Different Bone Loss Levels
3.5. Stress Distribution Pattern of Each Component of the CZ Model with Different Bone Loss Levels
4. Discussion
5. Conclusions
- With marginal bone loss exceeding 1.5 mm, the maximum von Mises stress obviously increases on the screw and fixture regardless of the connection system or abutment materials. Among the factors, peri-implant bone loss affects the magnitude and distribution of the stress on the implant assembly the most.
- With bone loss progression, the connection system drives the distribution pattern of the stress on the screw. The stress concentrates the least on the abutment among the three components of the implant assembly. Moreover, both titanium and zirconia abutments are safe for clinical use.
- In this study, the stress on the screw in the external hexagon connection system sharply increased to >25% when bone loss increased from 3 to 5 mm—exceeding the yield strength of titanium alloy (Ti–6Al–4V) and, thus, increasing the screw loosening or fracture risk. Moreover, the stress on the fixture with the internal hexagon connection system sharply increased when the bone loss was ≥1.5 mm—exceeding the yield strength of pure titanium. Therefore, marginal bone maintenance is critical for conserving an implant assembly’s integrity.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Buser, D.; Chappuis, V.; Belser, U.C.; Chen, S. Implant placement post extraction in esthetic single tooth sites: When immediate, when early, when late? Periodontology 2000 2017, 73, 84–102. [Google Scholar] [CrossRef] [PubMed]
- Pjetursson, B.E.; Zarauz, C.; Strasding, M.; Sailer, I.; Zwahlen, M.; Zembic, A. A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin. Oral Implants Res. 2018, 29, 160–183. [Google Scholar] [CrossRef]
- Albrektsson, T.; Zarb, G.; Worthington, P.; Eriksson, A.R. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int. J. Oral Maxillofac. Implants 1986, 1, 11–25. [Google Scholar] [PubMed]
- Smith, D.E.; Zarb, G.A. Criteria for success of osseointegrated endosseous implants. J. Prosthet. Dent. 1989, 62, 567–572. [Google Scholar] [CrossRef]
- Jung, R.E.; Zembic, A.; Pjetursson, B.E.; Zwahlen, M.; Thoma, D.S. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin. Oral Implants Res. 2012, 23, 2–21. [Google Scholar] [CrossRef] [PubMed]
- Berglundh, T.; Persson, L.; Klinge, B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J. Clin. Periodontol. 2002, 29, 197–212. [Google Scholar] [CrossRef]
- Smith, D.C. Dental implants: Materials and design considerations. Int. J. Prosthodont. 1993, 6, 106–117. [Google Scholar]
- Osman, R.B.; Swain, M.V. A Critical Review of Dental Implant Materials with an Emphasis on Titanium versus Zirconia. Materials 2015, 5, 932–958. [Google Scholar] [CrossRef]
- Sailer, I.; Philipp, A.; Zembic, A.; Pjetursson, B.E.; Hämmerle, C.H.; Zwahlen, M. A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin. Oral Implants Res. 2009, 20, 4–31. [Google Scholar] [CrossRef]
- Gracis, S.; Michalakis, K.; Vigolo, P.; Vult von Steyern, P.; Zwahlen, M.; Sailer, I. Internal vs. external connections for abutments/reconstructions: A systematic review. Clin. Oral Implants Res. 2012, 23, 202–216. [Google Scholar] [CrossRef]
- Schwarz, F.; Derks, J.; Monje, A.; Wang, H.L. Peri-implantitis. J. Clin. Periodontol. 2018, 45, 246–266. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Berglundh, T.; Armitage, G.; Araujo, M.G.; Avila-Ortiz, G.; Blanco, J.; Camargo, P.M.; Chen, S.; Cochran, D.; Derks, J.; Figuero, E.; et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J. Clin. Periodontol. 2018, 45, 286–291. [Google Scholar] [CrossRef] [PubMed]
- Dreyer, H.; Grischke, J.; Tiede, C.; Eberhard, J.; Schweitzer, A.; Toikkanen, S.E.; Glöckner, S.; Krause, G.; Stiesch, M. Epidemiology and risk factors of peri-implantitis: A systematic review. J. Periodontal Res. 2018, 53, 657–681. [Google Scholar] [CrossRef]
- Derks, J.; Tomasi, C. Peri-implant health and disease. A systematic review of current epidemiology. J. Clin. Periodontol. 2015, 42, 158–171. [Google Scholar] [CrossRef] [PubMed]
- Kitamura, E.; Stegaroiu, R.; Nomura, S.; Miyakawa, O. Biomechanical aspects of marginal bone resorption around osseointegrated implants: Considerations based on a three-dimensional finite element analysis. Clin. Oral. Implants Res. 2004, 15, 401–412. [Google Scholar] [CrossRef]
- Michailidis, N.; Karabinas, G.; Tsouknidas, A.; Maliaris, G.; Tsipas, D.; Koidis, P. A FEM based endosteal implant simulation to determine the effect of peri-implant bone resorption on stress induced implant failure. Biomed. Mater. Eng. 2013, 23, 317–327. [Google Scholar] [CrossRef]
- Yenigun, S.; Ercal, P.; Ozden-Yenigun, E.; Katiboglu, A.B. Influence of Abutment Design on Stress Distribution in Narrow Implants with Marginal Bone Loss: A Finite Element Analysis. Int. J. Oral Maxillofac. Implants 2021, 36, 640–649. [Google Scholar] [CrossRef]
- Gupta, S.; Goyal, P.; Jain, A.; Chopra, P. Effect of peri-implantitis associated horizontal bone loss on stress distribution around dental implants—A 3D finite element analysis. Mater. Today 2020, 28, 1503–1509. [Google Scholar] [CrossRef]
- Jimbo, R.; Halldin, A.; Janda, M.; Wennerberg, A.; Vandeweghe, S. Vertical fracture and marginal bone loss of internal-connection implants: A finite element analysis. Int. J. Oral Maxillofac. Implants 2013, 28, 171–176. [Google Scholar] [CrossRef]
- Gasik, M.; Lambert, F.; Bacevic, M. Biomechanical Properties of Bone and Mucosa for Design and Application of Dental Implants. Materials 2021, 14, 2845. [Google Scholar] [CrossRef]
- Akça, K.; Iplikçioğlu, H. Finite element stress analysis of the influence of staggered versus straight placement of dental implants. Int. J. Oral Maxillofac. Implants 2001, 16, 722–730. [Google Scholar] [PubMed]
- Teixeira, E.R.; Sato, Y.; Akagawa, Y.; Shindoi, N. A comparative evaluation of mandibular finite element models with different lengths and elements for implant biomechanics. J. Oral Rehabil. 1998, 25, 299–303. [Google Scholar] [CrossRef] [PubMed]
- Pierrisnard, L.; Hure, G.; Barquins, M.; Chappard, D. Two dental implants designed for immediate loading: A finite element analysis. Int. J. Oral Maxillofac. Implants 2002, 17, 353–362. [Google Scholar] [PubMed]
- Kohal, R.J.; Papavasiliou, G.; Kamposiora, P.; Tripodakis, A.; Strub, J.R. Three-dimensional computerized stress analysis of commercially pure titanium and yttrium-partially stabilized zirconia implants. Int. J. Prosthodont. 2002, 15, 189–194. [Google Scholar]
- Alkan, I.; Sertgöz, A.; Ekici, B. Influence of occlusal forces on stress distribution in preloaded dental implant screws. J. Prosthet. Dent. 2004, 91, 319–325. [Google Scholar] [CrossRef]
- Yu, H.Y.; Cai, Z.B.; Zhou, Z.R.; Zhu, M.H. Fretting behavior of cortical bone against titanium and its alloy. Wear 2005, 259, 910–918. [Google Scholar] [CrossRef]
- Grant, J.A.; Bishop, N.E.; Götzen, N.; Sprecher, C.; Honl, M.; Morlock, M.M. Artificial composite bone as a model of human trabecular bone: The implant-bone interface. J. Biomech. 2007, 40, 1158–1164. [Google Scholar] [CrossRef]
- Lee, S.H.; Hong, M.; Lee, K. Finite Element Analysis of Screw-Tightening Torque Applied to Custom and Conventional Abutment. Glob. J. Health Sci. 2017, 9, 165. [Google Scholar] [CrossRef]
- Farah, J.W.; Craig, R.G. Finite element stress analysis of a restored axisymmetric first molar. J. Dent. Res. 1974, 53, 859–866. [Google Scholar] [CrossRef]
- Van Staden, R.C.; Guan, H.; Loo, Y.C. Application of the finite element method in dental implant research. Comput. Methods Biomech. Biomed. Engin. 2006, 9, 257–270. [Google Scholar] [CrossRef]
- Binon, P.P. Implants and components: Entering the new millennium. Int. J. Oral Maxillofac. Implants 2000, 15, 76–94. [Google Scholar] [PubMed]
- Möllersten, L.; Lockowandt, P.; Lindén, L.A. Comparison of strength and failure mode of seven implant systems: An in vitro test. J. Prosthet. Dent. 1997, 78, 582–591. [Google Scholar] [CrossRef]
- Yamanishi, Y.; Yamaguchi, S.; Imazato, S.; Nakano, T.; Yatani, H. Influences of implant neck design and implant-abutment joint type on peri-implant bone stress and abutment micromovement: Three-dimensional finite element analysis. Dent. Mater. 2012, 28, 1126–1133. [Google Scholar] [CrossRef] [PubMed]
- Maeda, Y.; Satoh, T.; Sogo, M. In vitro differences of stress concentrations for internal and external hex implant-abutment connections: A short communication. J. Oral Rehabil. 2006, 33, 75–78. [Google Scholar] [CrossRef]
- de Medeiros, R.A.; Pellizzer, E.P.; Vechiato Filho, A.J.; Dos Santos, D.M.; da Silva, E.V.; Goiato, M.C. Evaluation of marginal bone loss of dental implants with internal or external connections and its association with other variables: A systematic review. J. Prosthet. Dent. 2016, 116, 501–506.e5. [Google Scholar] [CrossRef]
- Camps-Font, O.; Rubianes-Porta, L.; Valmaseda-Castellón, E.; Jung, R.E.; Gay-Escoda, C.; Figueiredo, R. Comparison of external, internal flat-to-flat, and conical implant abutment connections for implant-supported prostheses: A systematic review and network meta-analysis of randomized clinical trials. J. Prosthet. Dent. 2021. advance online publication. [Google Scholar] [CrossRef]
- Lemos, C.; Verri, F.R.; Bonfante, E.A.; Santiago Júnior, J.F.; Pellizzer, E.P. Comparison of external and internal implant-abutment connections for implant supported prostheses. A systematic review and meta-analysis. J. Dent. 2018, 70, 14–22. [Google Scholar] [CrossRef]
- Chai, J.; Chu, F.C.; Chow, T.W.; Liang, B.M. Chemical solubility and flexural strength of zirconia-based ceramics. Int. J. Prosthodont. 2007, 20, 587–595. [Google Scholar]
- Bottino, M.A.; de Oliveira, F.R.; Sabino, C.F.; Dinato, J.C.; Silva-Concílio, L.R.; Tribst, J.P.M. Survival Rate and Deformation of External Hexagon Implants with One-Piece Zirconia Crowns. Metals 2021, 11, 1068. [Google Scholar] [CrossRef]
- Zembic, A.; Bösch, A.; Jung, R.E.; Hämmerle, C.H.; Sailer, I. Five-year results of a randomized controlled clinical trial comparing zirconia and titanium abutments supporting single-implant crowns in canine and posterior regions. Clin. Oral Implants Res. 2013, 24, 384–390. [Google Scholar] [CrossRef]
- Gehrke, S.A.; Poncio da Silva, P.M.; Calvo Guirado, J.L.; Delgado-Ruiz, R.A.; Dedavid, B.A.; Aline Nagasawa, M.; Shibli, J.A. Mechanical behavior of zirconia and titanium abutments before and after cyclic load application. J. Prosthet. Dent. 2016, 116, 529–535. [Google Scholar] [CrossRef]
- Nakamura, K.; Kanno, T.; Milleding, P.; Ortengren, U. Zirconia as a dental implant abutment material: A systematic review. Int. J. Prosthodont. 2010, 23, 299–309. [Google Scholar] [PubMed]
- Piconi, C.; Maccauro, G. Zirconia as a ceramic biomaterial. Biomaterials 1999, 20, 1–25. [Google Scholar] [CrossRef]
- Mizumoto, R.M.; Malamis, D.; Mascarenhas, F.; Tatakis, D.N.; Lee, D.J. Titanium implant wear from a zirconia custom abutment: A clinical report. J. Prosthet. Dent. 2020, 123, 201–205. [Google Scholar] [CrossRef] [PubMed]
- Chang, Y.T.; Wu, Y.L.; Chen, H.S.; Tsai, M.H.; Chang, C.C.; Wu, A.Y.J. Comparing the Maximum Load Capacity and Modes of Failure of Original Equipment Manufactured and Aftermarket Titanium Abutments in Internal Hexagonal Implants. Metals 2020, 10, 556. [Google Scholar] [CrossRef]
- Tsuge, T.; Hagiwara, Y. Influence of lateral-oblique cyclic loading on abutment screw loosening of internal and external hexagon implants. Dent. Mater. J. 2009, 28, 373–381. [Google Scholar] [CrossRef]
- Saidin, S.; Abdul Kadir, M.R.; Sulaiman, E.; Abu Kasim, N.H. Effects of different implant-abutment connections on micromotion and stress distribution: Prediction of microgap formation. J. Dent. 2012, 40, 467–474. [Google Scholar] [CrossRef]
- Bing, L.; Mito, T.; Yoda, N.; Sato, E.; Shigemitsu, R.; Han, J.M.; Sasaki, K. Effect of peri-implant bone resorption on mechanical stress in the implant body: In vivo measured load-based finite element analysis. J. Oral Rehabil. 2020, 47, 1566–1573. [Google Scholar] [CrossRef]
- Yoon, K.H.; Kim, S.G.; Lee, J.H.; Suh, S.W. 3D finite element analysis of changes in stress levels and distributions for an osseointegrated implant after vertical bone loss. Implant Dent. 2011, 20, 354–359. [Google Scholar] [CrossRef]
- Pietroń, K.; Mazurkiewicz, Ł.; Sybilski, K.; Małachowski, J. Correlation of Bone Material Model Using Voxel Mesh and Parametric Optimization. Materials 2022, 15, 5163. [Google Scholar] [CrossRef]
- Chang, Y.T.; Wu, Y.L.; Chen, H.S.; Tsai, M.H.; Chang, C.C.; Wu, A.Y.J. Comparing the Fracture Resistance and Modes of Failure in Different Types of CAD/CAM Zirconia Abutments with Internal Hexagonal Implants: An In Vitro Study. Materials 2022, 15, 2656. [Google Scholar] [CrossRef]
- Sivaraman, K.; Chopra, A.; Narayan, A.I.; Balakrishnan, D. Is zirconia a viable alternative to titanium for oral implant? A critical review. J. Prosthodont. Res. 2018, 62, 121–133. [Google Scholar] [CrossRef] [PubMed]
Group | Implant-Connection | Abutment | Bone Loss |
---|---|---|---|
ST0 | NobelSpeedy Groovy-external hexagon | Titanium | 0 mm |
ST1.5 | NobelSpeedy Groovy-external hexagon | Titanium | 1.5 mm |
ST3 | NobelSpeedy Groovy-external hexagon | Titanium | 3 mm |
ST5 | NobelSpeedy Groovy-external hexagon | Titanium | 5 mm |
SZ0 | NobelSpeedy Groovy-external hexagon | Zirconia | 0 mm |
SZ1.5 | NobelSpeedy Groovy-external hexagon | Zirconia | 1.5 mm |
SZ3 | NobelSpeedy Groovy-external hexagon | Zirconia | 3 mm |
SZ5 | NobelSpeedy Groovy-external hexagon | Zirconia | 5 mm |
CT0 | NobelParallel Conical Connection-internal hexagon | Titanium | 0 mm |
CT1.5 | NobelParallel Conical Connection-internal hexagon | Titanium | 1.5 mm |
CT3 | NobelParallel Conical Connection-internal hexagon | Titanium | 3 mm |
CT5 | NobelParallel Conical Connection-internal hexagon | Titanium | 5 mm |
CZ0 | NobelParallel Conical Connection-internal hexagon | Zirconia | 0 mm |
CZ1.5 | NobelParallel Conical Connection-internal hexagon | Zirconia | 1.5 mm |
CZ3 | NobelParallel Conical Connection-internal hexagon | Zirconia | 3 mm |
CZ5 | NobelParallel Conical Connection-internal hexagon | Zirconia | 5 mm |
Material | Young’s Modulus (GPa) | Poisson’s Ratio | Yield Strength (MPa) | Ultimate Strength (MPa) |
---|---|---|---|---|
Cortical bone | 13.4 [21] | 0.30 [21] | N/A | 121; 167 [21] * |
Cancellous bone | 1.37 [21] | 0.30 [21] | N/A | N/A |
Pure Titanium (implant fixture) | 115 [22] | 0.35 [22] | Min.750 ** | Min.860 ** |
Ti-6Al-4V alloy (screw, abutment) | 110 [23] | 0.33 [23] | Min.795 ** | Min.860 ** |
Zirconia (abutment) | 200 [24] | 0.31 [24] | N/A | 1120 *** |
Group | Elements (Sum) | Group | Elements (Sum) |
---|---|---|---|
ST0 | 209,327 | CT0 | 232,736 |
ST1.5 | 213,471 | CT1.5 | 236,901 |
ST3 | 195,462 | CT3 | 233,716 |
ST5 | 191,566 | CT5 | 232,922 |
SZ0 | 210,982 | CZ0 | 232,736 |
SZ1.5 | 203,038 | CZ1.5 | 237,038 |
SZ3 | 193,602 | CZ3 | 233,716 |
SZ5 | 191,621 | CZ5 | 232,922 |
Group | Abutment | Screw | Fixture | Cortical Bone | Cancellous Bone |
---|---|---|---|---|---|
ST0 | 477.00 | 556.67 | 315.35 | 51.42 | 1.85 |
ST1.5 | 466.38 | 614.57 | 561.82 | 64.83 | 4.00 |
ST3 | 646.06 | 657.49 | 571.44 | 124.52 | 8.27 |
ST5 | 625.07 | 864.76 | 572.11 | 110.16 | 13.99 |
SZ0 | 513.24 | 554.46 | 316.39 | 50.88 | 1.88 |
SZ1.5 | 512.46 | 630.99 | 576.54 | 62.94 | 4.82 |
SZ3 | 581.15 | 676.00 | 521.97 | 129.12 | 7.79 |
SZ5 | 549.94 | 858.02 | 546.26 | 110.16 | 13.99 |
CT0 | 441.05 | 598.18 | 623.89 | 106.20 | 2.51 |
CT1.5 | 519.83 | 726.76 | 856.26 | 107.97 | 4.61 |
CT3 | 572.70 | 759.67 | 855.76 | 115.84 | 8.18 |
CT5 | 606.20 | 725.37 | 854.95 | 160.43 | 16.72 |
CZ0 | 508.63 | 593.91 | 590.51 | 102.30 | 2.57 |
CZ1.5 | 517.94 | 758.36 | 796.64 | 109.17 | 4.60 |
CZ3 | 612.64 | 760.15 | 811.90 | 115.96 | 8.18 |
CZ5 | 554.16 | 727.79 | 813.04 | 160.19 | 16.74 |
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Lin, C.-P.; Shyu, Y.-T.; Wu, Y.-L.; Tsai, M.-H.; Chen, H.-S.; Wu, A.Y.-J. Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant–Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study. Materials 2022, 15, 5866. https://doi.org/10.3390/ma15175866
Lin C-P, Shyu Y-T, Wu Y-L, Tsai M-H, Chen H-S, Wu AY-J. Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant–Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study. Materials. 2022; 15(17):5866. https://doi.org/10.3390/ma15175866
Chicago/Turabian StyleLin, Ching-Ping, Yi-Ting Shyu, Yu-Ling Wu, Ming-Hsu Tsai, Hung-Shyong Chen, and Aaron Yu-Jen Wu. 2022. "Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant–Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study" Materials 15, no. 17: 5866. https://doi.org/10.3390/ma15175866