Finite element analysis (FEA) has been used extensively to predict the biomechanical performance of various dental implant designs as well as the effect of clinical factors on implant success. By understanding the basic theory, method, application, and limitations of FEA in implant dentistry, the clinician will be better equipped to interpret results of FEA studies and extrapolate these results to clinical situations. This article reviews the current status of FEA applications in implant dentistry and discusses findings from FEA studies in relation to the bone-implant interface, the implant-prosthesis connection, and multiple-implant prostheses.

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Application of finite element analysis in implant dentistry: A review of the literature

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications.

With an ageing population, war, and sports related injuries there is an ever-expanding requirement for hard tissue replacement such as bone. Engineered artificial scaffold biomaterials with appropriate mechanical properties, surface chemistry and surface topography are in a great demand for enhancing cell attachment, cell growth and tissue formation at such defect sites. Most of these engineering techniques are aimed at mimicking the natural organization of the bone tissues and thereby create a conducive environment for bone regeneration. As the interaction between the cells and tissues with biomaterials at the tissue–implant interface is a surface phenomenon, surface properties play a major role in determining both the biological response to implants and the material response to the physiological condition. Hence surface engineering of biomaterials is aimed at modifying the material and biological responses through changes in surface properties while still maintaining the bulk mechanical properties of the implant. Therefore, there has been a great thrust towards development of Ca–P-based surface coatings on various metallic and nonmetallic substrates for load bearing implant applications such as hip joint prosthesis, knee joint prosthesis and dental implants. Typical coating methodologies like ion beam assisted deposition, plasma spray deposition, pulsed laser physical vapor deposition, magnetron sputtering, sol–gel derived coatings, electrodeposition, micro-arc oxidation and laser deposition are extensively studied at laboratory scale. In the present article, attempts are made to give an overview of the basic principles behind the coating techniques as well as advantageous features such as bioactivity and biocompatibility associated with these coatings. A strong emphasis will be given on laser-induced textured and bioactive coatings obtained by the author's research group [A. Kurella, N.B. Dahotre, Journal of Biomedical Applications 20 (2005) 5–50; A. Kurella, N.B. Dahotre, Acta Biomaterialia 2 (2006) 677–688; A. Kurella, N.B. Dahotre, Journal of Minerals, Metals and Materials Society (JOM) 58 (2006) 64–66; A. Kurella, N.B. Dahotre, Journal of Materials Science: Materials in Medicine 17 (2006) 565–572; P.G. Engleman, A. Kurella, A. Samant, C.A. Blue, N.B. Dahotre, Journal of Minerals, Metals and Materials Society (JOM) 57 (2005) 46–50; R. Singh, A. Kurella, N.B. Dahotre, Journal of Biomaterials Applications 21 (2006) 46–72; S.R. Paital, N.B. Dahotre, Biomedical Materials 2 (2007) 274–281; S.R. Paital, N.B. Dahotre, 2009, Acta Biomaterialia, doi:10.1016/j.actbio.2009.03.004 ; R. Singh, N.B. Dahotre, Journal of Materials Science: Materials in Medicine 18 (2007) 725–751.]. Since cells are sensitive to topographical features ranging from mesoscale to nanoscale, formation of these features by both pulsed and continuous wave Nd:YAG laser system will be highlighted. This can also be regarded as advancement towards third generation biomaterials which are bioinert, bioactive and which once implanted will stimulate cell adhesion, proliferation and growth at the interface. Further, an overview of various bio-implants and bio-devices and materials used for these kinds of devices, performance factors such as mechanical and corrosion behavior and surface science associated with these materials are also explained. As the present article is aimed at describing the multidisciplinary nature of this exciting field it also provides a common platform to understand this subject in a simple way for students, researchers, teachers and engineers in the fields ranging from medicine, dentistry, biology, materials science, biomedicine, biomechanics to physics.

Calcium phosphate coatings for bio-implant applications: Materials, performance factors, and methodologies

Calcium phosphate coatings on magnesium alloys for biomedical applications: a review.

Since dental implants must withstand relatively large forces and moments in function, a better understanding of in vivo bone response to loading would aid implant design. The following topics are essential in this problem. (1) Theoretical models and experimental data are available for understanding implant loading as an aid to case planning. (2) At least for several months after surgery, bone healing in gaps between implant and bone as well as in pre-existing damaged bone will determine interface structure and properties. The ongoing healing creates a complicated environment. (3) Recent studies reveal that an interfacial cement line exists between the implant surface and bone for titanium and hydroxyapatite (HA). Since cement lines in normal bone have been identified as weak interfaces, a cement line at a bone-biomaterial interface may also be a weak point. Indeed, data on interfacial shear and tensile "bond" strengths are consistent with this idea. (4) Excessive interfacial micromotion early after implantation interferes with local bone healing and predisposes to a fibrous tissue interface instead of osseointegration. (5) Large strains can damage bone. For implants that have healed in situ for several months before being loaded, data support the hypothesis that interfacial overload occurs if the strains are excessive in interfacial bone. While bone "adaptation" to loading is a long-standing concept in bone physiology, researchers may sometimes be too willing to accept this paradigm as an exclusive explanation of in vivo tissue responses during experiments, while overlooking confounding variables, alternative (non-mechanical) explanations, and the possibility that different types of bone (e.g., woven bone, Haversian bone, plexiform bone) may have different sensitivities to loading under healing vs. quiescent conditions.

In vivo bone response to biomechanical loading at the bone/dental-implant interface.

Purpose A 3-dimensional finite element analysis was performed to evaluate the influence of implant type and length, as well as that of bone quality, on the stress/strain in bone and implant. Materials and methods Two types (screw and cylinder) and 4 lengths (9.2, 10.8, 12.4, and 14.0 mm) of titanium implants were buried in 4 types of bone modeled by varying the elastic modulus for cancellous bone. Axial and buccolingual forces were applied to the occlusal node at the center of the abutment. Results Regardless of load direction, maximum equivalent stress/strain in bone increased with a decrease in cancellous bone density. Under axial load, especially in the low-density bone models, maximum equivalent strain in cancellous bone was lower with the screw-type implant than with the cylinder-type implant. It was also lower with the longer implants than with the shorter implants. Under buccolingual load, equivalent stress/strain was influenced mainly by bone density. Discussion This study confirms the importance of bone quality and its presurgical diagnosis for implant long-term prognosis. Implant length and type can also influence bone strain, especially in low-density bone. Conclusions The results of this study suggest that cancellous bone of higher rather than lower density might ensure a better biomechanical environment for implants. Moreover, longer screw-type implants could be a better choice in a jaw with cancellous bone of low density.

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Influence of implant design and bone quality on stress/strain distribution in bone around implants: a 3-dimensional finite element analysis.

Objectives: Although bone loss around implants is reported as a complication when it progresses uncontrolled, resorption does not always lead to implant loss, but may be the result of biomechanical adaptation to stress. To verify this hypothesis, a three-dimensional finite element analysis was performed and the influence of marginal bone resorption amount and shape on stress in the bone and implant was investigated.

Material and methods: A total of nine bone models with an implant were created: a non-resorption (Base) model and eight variations, in which three different resorption depths were combined with pure vertical or conical (vertical–horizontal) resorption. Axial and buccolingual forces were applied independently to the occlusal node at the center of the superstructure.

Results: Regardless of load direction, bone stresses were higher in the pure vertical resorption (A) models than in the Base model, and increased with resorption depth. However, cortical bone stress was much lower in the conical resorption models than in both the Base and A models of the same resorption depth. An opposite tendency was observed in the cancellous bone under buccolingual load.

Under buccolingual load, highest stress in the implant increased linearly with the resorption depth for all the models and its location approached the void existing below the abutment screw.

Conclusions: The results of this analysis suggest that a certain amount of conical resorption may be the result of biomechanical adaptation of bone to stress. However, as bone resorption progresses, the increasing stresses in the cancellous bone and implant under lateral load may result in implant failure.

Biomechanical aspects of marginal bone resorption around osseointegrated implants: considerations based on a three-dimensional finite element analysis.

Statement of Problem. Because of reported mechanical failures, alternative implant system components with suggested optimized strength have been manufactured. However, the endurance of these products has not been well investigated. Purpose. This study was designed to assess the effect of joint design on the fatigue strength and failure mode of 2 single-tooth implant systems: Branemark and ITI, in which a hex mediated-butt joint and 8-degree internal conical implant/abutment interface are used, respectively. Material and Methods. Seven 10-mm implants from each implant system were embedded to a depth of 7 mm in cylindrical acrylic resin blocks. CeraOne and Solid abutments with cement-retained castings were assembled to the Branemark and ITI implants, respectively. The assembled units were mounted in a lever-type-testing machine that was equipped with an automatic counting device and shutoff sensors, enabling the recording of the number of cycles till failure. A cyclic load of 100 N was applied perpendicular to the long axis of the assemblies at a rate of 75 cycles/min. To investigate specimen resistance to fatigue during 6 years of simulated function, a target of 1,800,000 cycles was defined. Specimen preparation and testing was performed by the same operator. The association of the joint design with the occurrence of failure was verified by Fisher's exact probability test ( P Results. For the Branemark group, the gold alloy abutment screw in all specimens fractured between 1,178,023 and 1,733,526 cycles with a standard deviation of 224,477 cycles. For the ITI group, all specimens had no failure until 1,800,000 cycles. Statistical analysis showed a highly significant difference between the 2 groups ( P =.000582). Conclusion. Within the limitations of this in vitro study, the effect of joint design on the fatigue strength and failure mode of the ITI single tooth implant system was significantly better ( P >.001) than the Branemark single-tooth implant system tested. (J Prosthet Dent 2002;88:604-10.)

Fatigue resistance of two implant/abutment joint designs.

The three-dimensional finite element analysis method was used to assess stress in bone around titanium implants using three treatment designs for a partially edentulous mandible, under axial (AX), buccolingual (BL), or mesiodistal (MD) loads. For each of these loads, highest stress was calculated in the model with a cantilever prosthesis supported by two implants (M2). Less stress was found in the model with a conventional fixed partial denture on two implants (M3), and lowest stress was calculated in the model with three connected crowns supported by three implants (M1). When BL load was applied to M3, cortical bone stress was high, comparable to that calculated for M2 under the same load. When AX or MD load was applied to M3, the cortical bone stress was low, similar to that found in M1 under each of these loads.

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Influence of restoration type on stress distribution in bone around implants: a three-dimensional finite element analysis.

Statement of problem Efforts to reduce the recurrence of abutment screw loosening with single tooth implant-supported restorations have been reported. However, the current knowledge about the role of the implant external hexagon is incomplete. Purpose This in vitro study investigated the effect of lateral cyclic loading with different load positions on abutment screw loosening of an external hexagon implant system. Material and methods Fifteen Branemark implant assemblies were divided equally into 3 groups, A, B, and C. Each assembly consisted of a Mark IV implant (4 × 10 mm) mounted in a brass block, a CeraOne abutment (3 mm), and an experimental cement-retained superstructure. For group A, a cyclic load of 50 N was applied centrally and perpendicular to the long axis of the implant, whereas for group B, the same load was applied eccentrically (at a distance of 4 mm) in a loosening direction. A target of 1.0×10 6 cycles (40 months of simulated function) was defined. Group C (control) was left unloaded for the same loading time period as groups A and B. Reverse torque was recorded before and after loading and the difference was calculated. The data were analyzed with 1-way analysis of variance and compared with the Tukey test (α=.05). Results Group A exhibited a significant difference in the reverse torque difference values ([−5.6 to −3.4] ± 0.86 N·cm) compared with groups B ([−1.9 to 0.5] ± 0.99 N·cm) and C ([−0.7 to 0.0] ± 0.26 N·cm) ( P Conclusion Within the limitations of this study, reverse torque values of the screw joint were preserved under eccentric lateral loading, as compared with centric loading ( P

Osamu Miyakawa

Papers

Influence of implant design and bone quality on stress/strain distribution in bone around implants: a 3-dimensional finite element analysis.

Biomechanical aspects of marginal bone resorption around osseointegrated implants: considerations based on a three-dimensional finite element analysis.

Fatigue resistance of two implant/abutment joint designs.

Influence of restoration type on stress distribution in bone around implants: a three-dimensional finite element analysis.

Effect of lateral cyclic loading on abutment screw loosening of an external hexagon implant system