Stress Evaluation of Dental Implant Wall Thickness using Numerical Techniques

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1 Stress Evaluation of Dental Implant Wall Thickness using Numerical Techniques Rudi C. van Staden 1, Hong Guan 1, Yew-Chae Loo 1, Newell W. Johnson 2, Neil Meredith 3, 1 Grif th School of Engineering, Grif th Universit Gold Coast Campus, Australia; 2 School of Dentistr and Oral Health, Grif th Universit Gold Coast Campus, Australia; 3 Neoss Ltd, Harrogate, United Kingdom Using the Finite Element Method, four implant diameters were evaluated for their effect on the stress distribution at the implant wall. A two-dimensional model of the implant and mandibular bone used triangular and quadrilateral plane strain elements to compute the von Mises stress in the bone with varied masticator forces and abutment screw preloads. The masticator force is found to be more influential than abutment screw preload, and implant wall thickness significantl infl uences the stress magnitude within the implant. INTRODUCTION Development of an ideal substitute for missing teeth has been a major aim of dental practitioners for millennia (Irish 2004). Dental implants are biocompatible threaded titanium fitures surgicall inserted into the mandible or mailla to replace missing teeth. The establishment of a good biomechanical link between implant and jawbone is called osseointegration (Branemark et al. 1969, 1977). The success of osseointegration depends on man factors including: medical status of the patient, smoking habits, bone qualit, bone grafting, disturbance, sensation or its disruption, haematoma, haemorrhage, tooth necrosis, irradiation therap, parafunctions, operator eperience, degree of surgical trauma, bacterial contamination, lack of preoperative antibiotics, immediate loading, nonsubmerged procedure and implant surface characteristics (Esposito et al. 1998). Ecessive surgical trauma and impaired healing abilit, premature loading and infection are likel to be the most common causes for earl implant losses, whereas progressive chronic marginal infection (peri-implantitis) and overload in conjunction with host characteristics are the major reasons for delaed failures (Esposito et al. 1998). For both earl and late implant failures, loading is considered an important factor (Geng et al. 2001). The distribution and magnitude of stresses within the implant are influenced b the implant dimensions, as documented b (Huang et al. 2005, Capodiferro et al. 2006, Winklere et al. 2003, Naert et al. 1992, Tolman and Lane 1992). Catastrophic mechanical failure of the implant ma occur b implant fatigue (Huang et al. 2005, Capodiferro et al. 2006), implant fractures, veneering resin/ceramic fractures or other mechanical retention failures (Winklere et al. 2003, Naert et al. 1992, Tolman and Lane 1992). From an engineering perspective, an important criterion in designing an implant is to have a geometr that can minimie mechanical failure caused b an etensive range of loading. As part of the implantation process, the torque is applied to the abutment screw causing an equivalent preload or clamping force between the abutment and implant. This is to ensure that the various implant components are perfectl attached to each other. However, to date no published research appears to have investigated the influence of masticator forces and abutment screw preloading on stresses in implants of various diameters. Therefore, the aim of this stud is to evaluate the stress within an immediatel loaded implant under a range of masticator forces, abutment preloads and implant diameters. 39

2 Masticator force, F M = 200, 500, 1000N VV 1 Crown F M 45 o VV 2 VV 3 Abutment Abutment screw torque, T = 110, 320, 550Nmm (Equivalent abutment screw preload, = , , N) Implant (Diameter, D = 3.5, 4.0, 4.5, 5.5) (Length, L = 11mm) Cancellous bone (Young s modulus = 1GPa) Cortical bone (Young s modulus = 13.7GPa) (Thickness = 1.2mm) VV 4 Fied constraints Figure 1. Finite element model of implant, components, implant/bone interface and bone MATERIALS AND METHODS Modelling and simulation were performed using the Strand7 (2004) Finite Element Analsis (FEA) Sstem. First the implant and bone geometr were defined, then material properties for the implant and various bone components were assigned in terms of Young s modulus, Poisson s ratio and densit. The loading and restraint conditions were applied and the effect on the stress profile within the implant was evaluated. Modelling A two-dimensional (2D) representation of the implant and mandibular bone was analsed because this was considered to be equall accurate and more efficient in computation time, as three-dimensional (3D) modelling. Data were acquired for the bone dimensions b CT scanning. Two different tpes of bone, cancellous and cortical, were distinguished and the boundaries were identified in order to assign different material properties within the finite element model. Figure 1 shows an implant and mandible section with the loading and restraint conditions. Also shown in the figure are the parameters investigated in this stud. The implant is based on that used b Neoss (2006), it is conical with 2 degrees of taper and a helical thread. For the finite element model with D = 4.5mm, L = 11mm, Tcor = 1.2mm, 3314 plate elements and 3665 nodal points were used for the implant, 3804 elements and 4079 nodes for cancellous bone, and 1216 elements and 1453 nodes for cortical bone. The effect on stress in the implant wall under different mastication forces (FM) and abutment preload (FP) was evaluated. For all the possible parametric combinations, the von Mises stress along the line VV in the implant wall was investigated and is believed to pla a crucial role in the probabilit of implant fracture. As indicated in Figure 1 the von Mises stresses along the lines VV1-2, VV2-3 and VV3-4 are reported for all possible combinations of loading and diameters. The relative locations of these lines are also detailed in the figure. Each line is identified b its start and end points, so, for eample, line VV1-2 begins at VV1 and ends at VV2. These locations were suggested b clinicians to be prone to micro fractures. The range of implant diameters (3.5, 4.0, 4.5 and 5.5mm) is shown in Figure 2. Note that the cortical bone is constrained distall to represent normal function of the mandible. Figure 2. Finite element model showing different implant diameters 3.5mm 4.0mm 4.5mm 5.5mm 40

3 Mandible 2D Slice F M F M 45 o 2D Slice - Figure 3. Location of 2D slice in a mandible a) Top view b) Isometric view Plane strain elements The model represents a cross-sectional slice from the mandible (Figure 3). The arc length of the mandible is comparable to the width and depth of the slice. When the slice is subjected to in-plane (-) masticator forces (F M ), it is restrained from deforming out-of-plane (in the -ais) and it was assumed that all strains are confined in the -ais. To accuratel represent the mechanical behaviour of the bone and implant, 3-node triangular (Tri3) and 4-node quadrilateral (Quad4) plane strain elements were therefore used for the construction of the finite element models. Note that for plane strain elements each node has a complete set of spatial degrees of freedom including u and v. The constraints meant that nodes could onl translate in the - (u) and - (v) directions. Material properties The material properties adopted were specified in terms of Young s modulus, Poisson s ratio and densit for the implant and all associated components (Table 1). All materials were assumed to ehibit linear, homogeneous elastic behaviour. Loading conditions Loading conditions included the masticator force, F M, applied to the occlusal surface of the crown set at 200, 500 and 1000N, as shown in Figure 1, and applied at 45 o inclination in the plane (refer to Figure 1). A preload,, was applied to the abutment screw of magnitude , or N through the use of temperature sensitive elements. The technique for appling the masticator forces to the crown, and the preload applied to the abutment screw, are discussed below. Masticator force, F M During normal function the crown is subjected to oblique loads applied to the occlusal surface of the crown. These loads are a result of normal masticator function. The theoretical stud b Choi et al. (2005) suggests that this loading condition can be considered to represent all applied loads. The implant was restrained in the, and directions within the jawbone, assuming complete osseointegration at the bone and implant interface. Figure 1 shows the positions of the applied loading and restraints. Table 1. Material properties Component Description Young s Modulus, E (GPa) Poissons ratio, v Densit, (g/cm3) Implant, abutment, washer Titanium (grade 4) Abutment screw Gold (precision allo) Crown Zirconia (Y-TZP) Cancellous bone Cortical bone Cortical thickness = 1.2mm

4 Implant Abutment Abutment screw Manual screwdriver Preload, Fig. 4. Implant sstem Torque applied to top of abutment screw The torque applied to the abutment screw causes the preload or clamping forces between the implant and abutment. The procedure for calculating FP and appling a temperature sensitive element, functioning throughout the abutment screw developing the preload (or torque), is described below. Note that for the purpose of this article onl the Neoss sstem calculations for FP and temperature sensitive elements are shown as an eample. A dental implant sstem tpicall consists of a crown, abutment and abutment screw. The abutment screw is screwed with a manual screwdriver (Figure 4) into the internal thread of the implant. Finall, the crown is placed on to the abutment using cement at the crown and abutment interface. The nature of the forces clamping implant components together, and how the are generated and sustained, are not comprehensivel covered in the literature. Preload was considered in finite element modelling b Haack et al. 1995, Lang et al and Brne et al These studies were either based on complicated 3D modelling or did not specif the techniques used for replicating FP. For the purpose of this stud the calculation used to determine the preload is based on findings b Dekker (1995). The relationship between the torque applied to the abutment screw and the preload achieved was epressed b Dekker (1995) as: P T i ( 2 Equation 1. t r t n r n using the conditions listed in Table 2; Note that the effective radius (r t and r n ) is the distance between the geometric centre of the part (implant, abutment or abutment screw) and the circle of points through which the resultant contact forces between mating parts (implant, abutment or abutment screw) pass (refer to Figure 4). Calculations of the preload are shown in equation 2 below, using information derived in equation ( ) 320 F P ( ( ) 2 cos(28.72) Equation 2. Rearranging for ; ( = N ( ) ( ) 2 cos(28.72) ( ( ( Table 2. Conditions applied in equation 1 Abbreviation Description Magnitude Reference T in = torque applied to the abutment screw (Nmm) = 320 Neoss (2006) = preload created in the abutment screw (N) = Unknown factor P = the pitch of the abutment screw threads (mm) = 0.40 Neoss (2006) t 42 = the coefficient of friction between abutment screw thread surfaces and internal implant screw thread surfaces (dimensionless) = the effective contact radius between the inner implant thread and the abutment screw threads. (mm) = 0.26 Lang et al. (2003) r t = (r 3 + r 4 )/2 = ( )/2 Neoss (2006) = / 2 = 0.87 = the half-angle of the threads (degree) = Neoss (2006) n r n = the coefficient of friction between the face of the abutment screw and the upper surface of the abutment (dimensionless) = the effective radius of contact between the abutment and implant surface (mm) = 0.20 = (r 1 + r 2 )/2 = ( )/2 = / 2 = Lang et al. (2003) Neoss (2006)

5 Figure 5. Effective radius of abutment and abutment screw a) Abutment The preload clamping the abutment to the implant is transferred through two interfaces. The first interface (SA 1 ) is between the abutment and abutment screw and the second (SA 2 ), between the abutment screw threads and the inner threads of the implant (Figure 5). The calculated preload,, is assumed to act equall, as a pressure, q, across the first and second interfaces. Due to equilibrium, onl the pressure q, acting on SA 1 is considered in this stud. SA 1 = (π r 12 ) - (π r 22 ) = (π ) - (π 0.952) SA 1 = 2.27mm 2 Abutment T h e p r e s s u r e a c t i n g o n S A 1, w h e n = N, w a s c a l c u l a t e d a s f o l l ow s : FP q SA 1 Equation q = N/mm 2 r 2 r 1 SA 1 The clamping pressure, q, is a result of the applied torque and is a means of replicating the 3D torque in a 2D manner. For the present stud, q, is calculated as above for the applied torques of 110, 320 and 550Nmm (Table 3). b) Abutment screw In the analsis a negative temperature (-10 Kelvin, K) is applied to all the nodal points within the abutment screw, causing each element to shrink. A trial and error process is applied to determine the temperature coefficient, C, that can ield an equivalent q. The corresponding C is also presented in Table 3. C L SA 2 Abutment screw Table 3. Abutment screw torque (T), preload, and surface pressure q T (Nmm) (N) q (N/mm 2 ) C 3.5mm ( ) C 4.0mm ( ) C 4.5mm ( ) C 5.5mm ( )

6 RESULTS The distribution of von Mises stresses in the implant is discussed for all combinations of masticator and preload forces. Each parameter is discussed in a separate section for all four implant diameters. The von Mises stresses are reported between locations (0-1.51mm in length), ( mm) and NN 3-4 ( mm), as shown in Figure 1. Masticator Force, F M The distributions of von Mises stresses along the lines, and for all values of F M are shown in Figure 6. Note that the preload,, is set at its medium value, i.e N. In general, when the applied masticator force, F M, is increased, the von Mises stresses also increase proportionall, because the sstem being analsed is linear elastic. As epected the 3.5mm implant shows higher stresses than all other diameters (refer to Figures 6 a and b). The 3.5mm also indicates stress peaks along the lines VV1-2 and where all other parameters onl have elevated stress peaks along the line (Figures 6 a, c, e and g). This is because the implant wall thickness for the 3.5mm implant is significantl reduced in the region corresponding to, hence causing stress concentration. The 4.0 and 4.5mm diameter implants have similar stress distribution characteristics but the stresses are lower in magnitude at, and than with the 3.5mm implant because of the greater wall thickness (Figures 6 d and f). The 5.5mm implant displas greatl reduced stresses at all locations (Figures 6 g and h), with peak stresses occurring close to point VV 1 (see Figure 1). 44 Preload Force, To investigate the effect of different preload, F M is kept as a constant and its medium value, i.e. 500N is considered herein. The distributions of von Mises stresses along the lines, and for all values of are shown in Figure 7. Similar stress distribution characteristics were found when varing as with F M. Note that when increases, the von Mises stresses also increase. However, the increase is not proportional to the increase of.. This is because, as an internal force, is a function of the abutment screw and implant diameters. This suggests that failure of the crown is more likel to be caused b F M. DISCUSSION FEA has been used etensivel to predict the biomechanical and mechanical performance of implant designs as well as the effect of clinical factors on the success of implantation (DeTolla et al. 2000, Geng et al. 2001). The principal difficult in simulating the mechanical behaviour of implants is the modelling of the living human bone tissue and its response to applied mechanical forces (van Staden et al. 2006). A few studies have considered the influence of such factors as the torque (Lang et al.2003) with which the abutment is connected, and the effect of masticator forces on the probabilit of implant failure or loosening (Brne et al. 2006). This paper considers various combinations of loading parameters and their influence on the stress produced within implants of diameters 3.5, 4.0, 4.5 and 5.5mm. As epected, increased masticator forces lead to greater stresses within the implant. The preload applied to the abutment has less influence on the stresses than the masticator forces. The 3.5mm implant shows higher stresses than all other diameters and indicates stress peaks along the lines and where all other parameters onl have elevated stress peaks along the line. The 4.0 and 4.5mm diameter implants have similar stress distribution characteristics and the 5.5mm implant displas greatl reduced stresses at all locations, with peak stresses occurring close to point VV 1. CONCLUSION Overall, it was found that the masticator force is more influential on implant stresses than the abutment screw preload. As epected the implant wall thickness significantl influences the stress magnitude within the implant. Note also that when the wall thickness is decreased (especiall for the 3.5mm) stress concentration occurs at the internal and eternal threads as well as at sharp corners of the implant wall. Characteristicall the stress showed an increase at the top of the implant thread and the top of the implant (line ). It should be noted that this research was a pilot stud aimed at offering an initial understanding of the complicated stress distribution characteristics due to the various parameters. Other parameters which ma be evaluated for their influence on implant stress

7 F M = 200N, F M = 500N, F M = 1000N, a) Stress profile b) Stress contour F M = 200N, F M = 500N, F M = 1000N, c) Stress profile d) Stress contour Figure 6. Stress characteristics when varing F M. F M = 200N, F M = 500N, F M = 1000N, e) Stress profile f) Stress contour F M = 200N, F M = 500N, F M = 1000N, g) Stress profile h) Stress contour Figure 6. Stress characteristics when varing F M. 45

8 = N, = N, = N, a) Stress profile b) Stress contour = N, = N, = N, c) Stress profile d) Stress contour = N, = N, = N, e) Stress profile f) Stress contour = N, = N, = N, g) Stress profile h) Stress contour Figure 7. Stress characteristics when varing 46

9 profiles include the implant taper, pitch and design of implant thread, implant neck offset, different stages of bone remodelling and implant orientation within the bone. It is important that clinicians understand the methodolog, applications, and limitations of FEA in implant dentistr, and become more confident in interpreting results from FEA studies to clinical situations. ACKNOWLEDGEMENTS This work was made possible b the collaborative support from Griffith s School of Engineering and School of Dentistr and Oral Health. A special thank ou goes to Messer John Divitini and Fredrik Engman from Neoss Limited for their continual contribution. REFERENCES Branemark PI, Adell R, Breine U, Hansson BO, Lindstrom J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Eperimental studies. Scandinavian Journal of Plastic and Reconstructive Surger. 1969;3(2): Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Eperience from a 10-ear period. Scandinavian Journal of Plastic and Reconstructive Surger. 1977;16: in dental implant abutment screws. International Journal of Oral & Maillofacial Implants. 1995;10(5): Huang HM, Tsai CM, Chang CC, Lin CT, Lee SY. Evaluation of loading conditions on fatigue-failed implants b fracture surface analsis. International Journal of Oral & Maillofacial Implants. 2005;20(6): Irish JD. A 5,500 ear old artificial human tooth from Egpt: a historical note. International Journal of Oral & Maillofacial Implants. 2004;19(5): Lang LA, Kang B, Wang RF, Lang BR. Finite element analsis to determine implant preload. The Journal of Prosthetic Dentistr. 2003;90(6): Naert I, Quirnen M, van Steenberghe D, Darius P. A stud of 589 consecutive implants supporting complete fiture prostheses. Part II: prosthetic aspects. Journal of Prosthetic Dentistr. 1992;68: Neoss Limited (2006), Neoss Implant Sstem Surgical Guidelines, UK. Strand7 Pt Ltd (2004) Strand7 Theoretical Manual, Sdne, Australia. Tolman DE, Lane WR. Tissue integrated prosthesis complications. International Journal of Oral & Maillofacial Implants 1992;7: van Staden RC, Guan H, Loo YC. Application of the finite element method in dental implant research. Computer Methods in Biomechanical and Biomedical Engineering. 2006;9(4): Winkler S, Ring K, Ring JD, Boberick KG. Implant screw mechanics and the settling effect: overview. Journal of Oral Implantolog. 2003;29(5): Brne D, Jacobs S, O Connell B, Houston F, Claffe N. Preloads generated with repeated tightening in three tpes of screws used in dental implant assemblies. The Journal of Prosthetic Dentistr. 2006;15(3): Capodiferro S, Favia G, Scivetti M, De Frena G, Grassi R. Clinical management and microscopic characterisation of fatique-induced failure of a dental implant. Case report. Head & Face Medicine. 2006;22(2):18. Choi AH, Ben-Nissan B, Conwa RC. Three-dimensional modelling and finite element analsis of the human mandible during clenching. Australian Dental Journal. 2005;50(1): Dekker M. An introduction to the design and behavior of bolted joints / John H. Bickford. 1995;3rd ed. DeTolla DH, Andreana S, Patra A, Buhite R, Comella B. Role of the finite element model in dental implants. Journal of Oral Implantolog. 2000;26(2): Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. European Journal of Oral Sciences. 1998;106(3): Geng JP, Tan KB, Liu GR. Application of finite element analsis in implant dentistr: a review of the literature. Journal of Prosthetic Dentistr. 2001;85: Haack JE, Sakaguchi RL, Sun T, Coffe JP. Elongation and preload stress 47