Computers in Biology and Medicine 96 (2018) 157–165

Contents lists available at ScienceDirect

Computers in Biology and Medicine

journal homepage: www.elsevier.com/locate/compbiomed

Micro finite element analysis of dental implants under different

loading conditions
Petr Marci
an a, *, Jan Wolff b, Ladislava Hora
ckov

a c, Jozef Kaiser d, Tom

as Zikmund d,
Libor Bor
ak a

a
Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czech Republic
b
Department of Oral and Maxillofacial Surgery/Oral Pathology and 3D Innovation Lab, VU University Medical Center, Amsterdam, The Netherlands
c
Department of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
d
X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology, Brno University of Technology, Brno, Czech Republic

A R T I C L E I N F O A B S T R A C T

Keywords: Osseointegration is paramount for the longevity of dental implants and is significantly influenced by biome-
Micro finite element analysis chanical stimuli. The aim of the present study was to assess the micro-strain and displacement induced by loaded
Dental implants dental implants at different stages of osseointegration using finite element analysis (FEA). Computational models
Osseointegration of two mandible segments with different trabecular densities were constructed using microCT data. Three
Stress intensity different implant loading directions and two osseointegration stages were considered in the stress-strain analysis
Strain intensity
of the bone-implant assembly. The bony segments were analyzed using two approaches. The first approach was
based on Mechanostat strain intervals and the second approach was based on tensile/compression yield strains.
The results of this study revealed that bone surrounding dental implants is critically strained in cases when only a
partial osseointegration is present and when an implant is loaded by buccolingual forces. In such cases, implants
also encounter high stresses. Displacements of partially-osseointegrated implant are significantly larger than those
of fully-osseointegrated implants. It can be concluded that the partial osseointegration is a potential risk in terms
of implant longevity.

1. Introduction
Implant-supported fixed and removable restorations are to date
considered reliable treatment modalities for oral rehabilitation. Howev-
er, the effects of mechanical stimuli on the overall performance and
osseointegration of dental implants is still unclear [1,2]. Osseointegra-
tion is a dynamic process that involves complex cellular and molecular
activity in the bone-implant interface [3]. In this context, it must be noted
that mechanical loading affects the bone-implant contact (BIC) [4].
Moreover, excessive loading of the BIC might contribute to the devel-
opment of peri-implantitis and eventual implant loss. Fretting is another
phenomenon that can subsequently cause dental implant damage and
failure [5,6]. Therefore, studying the biomechanical variables in this
anatomical region is of great importance [7]. Strains, stresses and
implant displacements induced in/by the BIC are currently assessed using
experimental or computational modelling tools such as the finite element
method (FEM). The latter has become a very effective instrument to
investigate a large number of different configurations, material
combinations and dental implant designs [8]. In order to investigate BIC
performance, mechanical variables—especially mechanical strains—are
to date commonly interpreted according to Wolff's law [9] and the
Mechanostat hypothesis [10].
In computational simulations of the BIC, the implant and bone ge-
ometries and material properties of the different parts need to be taken
into account. Especially, complex bone geometry immediately support-
ing the implant is of great importance in terms of mechanical strain
analysis, as the trabecular network significantly affects the shape of the
stress and strain fields in question [11,12]. Therefore, computational
models of appropriate complexity should be employed when assessing
the BIC. The object- and site-specific trabecular architecture provides
more credible strain and stress distribution results, and with regards to
appropriate biomechanical interpretation methods, it might improve our
knowledge of biomechanical behavior of bones interacting with im-
plants, regardless of the exclusion of other biological aspects [4,7,12].
However, it must be noted that the use of such complex models is still not
common. Therefore, the aim of the present study was to examine the

* Corresponding author.
E-mail address: marcian@fme.vutbr.cz (P. Marci
an).

https://doi.org/10.1016/j.compbiomed.2018.03.012
Received 8 January 2018; Received in revised form 16 March 2018; Accepted 16 March 2018

0010-4825/© 2018 Elsevier Ltd. All rights reserved.

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biomechanical conditions in the BIC interface and the performance of
dental implants placed in a segment of human mandible using a complex
geometric model of bone, i.e. including a detailed trabecular architec-
ture. Special attention was paid to the biomechanical assessment of
various stages of osseointegration and various densities of the trabecular
architecture.
2. Methods
Two mandibular bony segments with different bone volume fractions
(BVF) were acquired from the Department of Anatomy, Faculty of Med-
icine, Masaryk University Brno, Czech Republic in full accordance with
relevant institutional and legislative requirements. The mandibular seg-
ments were harvested from the premolar region of two male cadavers
(see Fig. 1a). The segment width was approx. 18 mm.
The bone blocks were scanned using a microCT scanner (General
Electric v tome x L240, Boston, Massachusetts, USA), with a pixel size of
25 μm. These blocks were subsequently analyzed using histomorpho-
metric parameters (software VGStudio Max 3.1., Volume Graphics
GmbH, Germany). The BVF of the two bone blocks were 0.15 and 0.40.
Hereinafter, the bone blocks will be referred to as BVF_0.15 and
BVF_0.40.
2.1. Geometry model
The acquired microCT DICOM images of the two bone blocks were
converted into Standard Tessellation Language (STL) file formats and
subsequently used for the FEA simulations. Image processing was per-
formed using STL Model Creator software (Matlab 2012, Math Works,
Natick MA, USA) [13] to acquire 3D STL models of the trabecular and
cancellous bone architecture [4,7]. In order to reduce the computational
costs, the apical parts of both blocks were cut off as presented in Fig. 1b.
One STL model of a Branemark dental implant was used in this study
(diameter 3.3 mm and length 11.5 mm). The implant geometry was
created in SolidWorks 2012 (Dassault Syst
emes, France) and was sub-
sequently virtually placed into the STL models of the scanned bone
blocks.
2.2. Finite element model (meshing procedure)
The bone blocks and corresponding implants were assembled in
ANSYS18 (Swanson Analysis Systems Inc., Houston, PA, USA). Both
components were discretized using 10-node higher-order element SOLID
187 with a global size ranging from 0.05 mm to 0.5 mm (see Fig. 1b). The
FE model is described in detail elsewhere [4]. The connection of both
components (Bone block and implant) was modelled using standard
contact elements CONTA175 and TARGE170. The total number of ele-
ments was around 7.5 million with approx. 10 million nodes.
2.3. Loads (occlusal forces)
During mastication, teeth are commonly subjected to occlusal forces
of tens to hundreds of Newtons [14]. In the present study, occlusal forces
of approx. 150 N [15–18] were applied. The following three loading
directions were chosen to mimic physiological conditions in the oral
cavity (see Fig. 2a):
- 150 N acting in the implant axis; i.e. coronoapical direction (labelled
as Case “I”).
- 150 N at an angle of 45
to the implant axis and acting in the plane
parallel to the segment mesiodistal cuts (labeled as Case “II”).
- 150 N perpendicular to the implant axis and acting in the plane par-
allel to the segment mesiodistal cuts; i.e. buccolingual direction
(labeled as Case “III”).
Force was applied to the FE model through a pilot node (PN) located
10 mm from the coronal part of the implant.
2.4. Boundary and contact condition
In both BVF cases, the bone blocks were fixed [4,7] and total
osseointegration of the implants was assumed [19], i.e. the mutual
movement of the two different components was prevented. This condi-
tion was modelled using multipoint constraint (MPC) capabilities of the
contact elements introduced above [12] (see Fig. 2b):
- Dental implant fully osseointegrated (labeled as Case “A”).
- Dental implant partially osseointegrated (labeled as Case “B”). In this
case, a standard contact algorithm [7] with a frictional coefficient of
0.0 [20,21] was used for the non-osseointegrated part of the implant
(i.e. MPC was excluded here).

Fig. 1. Mandibular bone blocks a) microCT images of two morphologically different mandibular blocks were acquired from the premolar regions, b) typical finite
element models of bone blocks including dental implant.

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Fig. 2. Loading and boundary conditions, coordinate system definition: a) Force was applied through a pilot node (PN) in three different loading directions; b) Fully
(A) or partially (B) osseointegrated implant was attached to the bone using contact finite elements; c) Evaluations were performed to obtain displacements in buc-
colingual (X-axis) and coronoapical (Y-axis) directions. Strains in bone segments will be presented using buccal (View 1) and lingual (View 2) views.

Fig. 3. Summary of resulting implant displacements: a) Maximum displacements in buccolingual direction (UX); b) Maximum displacements in coronoapical di-
rection (UY).

2.5. Material properties 2.6. Biomechanical evaluations

The trabecular bone blocks were modelled assuming material line-
arity, homogeneity and elasticity; i.e. using two elastic constants, Young's
modulus (E) and Poisson's ratio (μ). Such a material representation can
accurately predict local displacements and strain distribution within the
bone model as was demonstrated by Costa et al. [22]. According to
current literature, the material properties of cancellous and cortical bone
are comparable at a micro level [23–25]. To date, there is a general
consensus that the Poisson's ratio values for the cortical bone are (μ ¼ 0.3
[26,27]); however, the specific value of the modulus is much less clear
and ranges from 5 to 30 GPa [28–30]. For the human mandible, the most
common reported value is 13.7 GPa [26,27,31,32]. The mechanical
properties of the titanium alloy implants used in this study were
E ¼ 110 GPa and μ ¼ 0.3 [33,34].
In total, 12 cases (2 bone blocks x 2 different osseointegration stages x
3 load directions) were analysed. Dental implant displacements, strain
intensity in the cancellous bone, and 1st and 3rd principal strains in the
cancellous bone and stress intensity in the dental implants were assessed.
2.7. Assessment of implant displacement
Dental implant displacements were evaluated in two directions rela-
tive to the implant axis, i.e., buccolingually and coronoapically (see
Fig. 2c).
2.8. Assessment of strains in bone tissue

The strain (or rather microstrain, με, defined as 1000 με ¼ 0.1%

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Fig. 4. Strain intensity results in the bone blocks for all evaluated cases. The contour scale is adjusted to correspond to the Mechanostat hypothesis thresholds (in
microstrains, με): a) Strain intensity distributions in cases with fully osseointegrated implant; b) Strain intensity distributions in cases with partially osseointe-
grated implant.

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Fig. 5. Strain intensity results: a) Analyzed volume of interest (VOI); b) Percentage of finite elements associated with Mechanostat-based intervals; c) Percentage of
finite elements associated with critical fracture interval only (strain intensity > 25000 με); d) Mechanostat-based intervals.
change of a length) on the bone was assessed using two different meth-
odologies. The first methodology was based on the Mechanostat hy-
pothesis that associates mechanical strain intensity (defined as the
difference between the algebraically largest principal strain and the
algebraically smallest principal strain at a given point) with the bone's
modelling, remodeling and microdamage thresholds [10,35]. According
to the hypothesis, a strain of 3000 με is a threshold between physiological
and pathological loading. Strains above 25000 με are considered to be
limiting in terms of the bone's structural integrity. Strain ranging be-
tween 1500 and 3000 με is considered to be physiological. The Mecha-
nostat methodology used in this study has been previously used to assess
strains in bone and is well established [20,36,37]. The second method-
ology was based on the comparison of the first and third principal strains
to tensile and compressive yield strains of 7300 με and 10400 με,
respectively [25]. The FE study methodology applied in this study has
already been used in multiple studies [38–40].
2.9. Assessment of stress in dental implant
All cases were evaluated only for stress intensity (defined as the dif-
ference between the algebraically largest principal stress and the alge-
braically smallest principal stress at a given point) that was considered to
be a decisive variable in the assessment of implant performance from a
structural point of view.
3. Results
3.1. Implant displacement
Implant displacements in the buccolingual direction (UX) are
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Computers in Biology and Medicine 96 (2018) 157–165
presented in Fig. 3a. The largest displacement (61.7 μm) was observed in
bone block BVF_015 with a partially osseointegrated implant (Case B)
that was loaded buccolingually (Case I). The results in coronoapical di-
rection (UY) are presented in Fig. 3b. A displacement of (11.5 μm) was
observed in both bone blocks BVF_0.40 and BVF_0.15 with partially
osseointegrated implants (Case B) that were loaded coronoapically (Case
I). Overall, the displacements of the partially osseointegrated implants
were higher than the fully osseointegrated implants.
3.2. Strains in bone tissue: mechanostat hypothesis
Strain intensity distributions in the bone tissue around the dental
implant are presented in Fig. 4. In this figure, the strain intensity distri-
bution is visualized in the mesiodistal sections of the bone block in both
buccal and lingual directions (see Fig. 2c). The plot colors correspond to
the strain thresholds of the Mechanostat hypothesis [10,35]. There were
six intervals associated with the Mechanostat hypothesis: (min, 500 με),
(500 με, 1000 με), (1000 με, 1500 με), (1500 με, 3000 με), (3000 με,
25000 με), and (25000 με, max). For the quantitative assessment of strain
intensity, volumes of interest (VOI) were defined in close proximity to the
implant. VOIs consisted of all finite elements representing the bone tissue
within a cylindrical shape that was 3 mm in diameter and had an axis
coincident with the axis of the implant. VOIs for segments BVF_0.15 and
BVF_0.40 were of 82.3 mm3 and 124.9 mm3, respectively. Average strain
intensity was assessed for each element within the VOI and was classified
according to Mechanostat strain intervals. Finally, the volumes of all
elements associated with each Mechanostat strain interval were divided
by the total VOI to obtain a share of that interval on the overall VOI
straining. Fig. 5.
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Fig. 6. 1st principal strain results: a) Percentage of finite elements associated with tensile-yield-based intervals: b) Percentage of finite elements associated with
critical fracture interval only (1st principal strain >7300 με): c) Tensile-yield-based intervals.
3.3. Strains in bone tissue: compression and tension limits
The second method for analyzing the performances of bone blocks
utilizes principal strains instead of the strain intensity used for
Mechanostat-based assessment. The finite elements within the blocks
were again classified using the same procedure as described in the pre-
vious paragraph. The only difference in comparison to the Mechanostat-
based assessment was in the definition of the strain intervals. There were
two intervals for the 1st principal strains ((min, 7300 με) and (7300 με,
max)) and another two intervals for the 3rd principal strains ((min,
10400 με) and (10400 με, max)). Shares of those intervals in the overall
VOI straining are provided in Fig. 6 and Fig. 7.
3.4. Stress in dental implant
Stress intensity distributions in the dental implants are presented in
Fig. 8a. Maximum values are summarized in the graph in Fig. 8b.
Maximal stresses were recorded between the first and second implant
thread (see Fig. 8a). The highest stresses were observed in the partially
osseointegrated implants loaded buccolingually. These stresses ranged
between 1251 MPa and 1098 MPa in BVF_0.15 and BVF_0.40, respec-
tively. The lowest stresses were observed in the fully osseointegrated
implants loaded coronoapically. These stresses were of 35 MPa and
67 MPa in BVF_0.15 and BVF_0.40, respectively.
4. Discussion
In this study, the coronoapical and buccolingual displacements of the
fully osseointegrated dental implants were below 7 μm, which is in good
agreement with other studies [4,41]. In the partially osseointegrated
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implants, the micromotion was significantly higher than that of the fully
osseointegrated implants; however, the maximum displacements were
less than 70 μm. During normal mastication, tooth displacements in both
coronoapical and buccolingual directions commonly range between 50
and 100 μm [42]. The overall micro-movement of fully osseointegrated
dental implants is, however, much lower than that of healthy teeth. The
movement of partially osseointegrated implants is similar to those of
natural teeth; however, it should be noted that the type of movement is
different in implants. In-situ, the tooth-bone connection is mediated by a
plethora of periodontal ligaments with strong supportive and damping
functionality. On the contrary, the implant-bone connection is deter-
mined by the stiffness of the interface. In the case of the partially
osseointegrated implant, a displacement of 70 μm could cause metal
fretting [43]. This observation suggests that imperfect osseointegration
might be a significant factor for fretting initiation.
The strain assessment in this study was conducted according to the
Mechanostat hypothesis and demonstrated that a fully osseointegrated
implant loaded the bone less, and the strain intensity in the bone was
distributed more evenly around the implant than in the case of partially
osseointegrated implants. When comparing the BVF_0.15 to the BVF_0.40
results, it can be concluded that less dense trabecular architecture leads
to an increased strain in the region of alveolar bone. Out of the three
investigated load cases, the cancellous bone performed worst during
buccolingual loading (Case III). This type of loading caused strain in-
tensities that exceeded the bone fracture limit regardless the BVF or stage
of osseointegration. This also applies to the loading Case II; however, the
share of VOI elements with critical strains was lower. Coronoapical
loading was the most favorable in terms of strain intensity.
The principal strain assessment according to critical compression and
tension limits showed similar results to those obtained from the
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Fig. 7. 3rd principal strain results: a) Percentage of finite elements associated with compression-yield-based intervals: b) Percentage of finite elements associated with
critical fracture interval only (3rd principal strain >10400 με): c) Compression-yield-based intervals.

Fig. 8. Stress intensity in the dental implants; a) results of all cases, b) summary of maximum stresses.

Mechanostat hypothesis. Only the coronoapical loading of the fully depending on the specifics of the trabecular architecture, cancellous bone
osseointegrated implants resulted in non-critical strain values. In other density, and the loading case. This observation is consistent with a recent
evaluated cases, the compression and tension limits were exceeded study by Marcian et al. [4].

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To date there is a general consensus [44] that peri-implant healing is
directly associated with bone remodeling. Such remodeling is heavily
driven by mechanical loading [45], i.e., exposing bone tissue to a certain
mechanical load commonly induces bone formation or bone loss (the
latter applies when too high or too low forces are exerted on a confined
area). Implant failures are very often associated with bone loss in the
crestal region [45]. This bone loss is often induced by biological factors
(such as inflammation) and/or by bone resorption due to occlusal over-
load. The results of the present study, as shown in Fig. 4a, revealed a high
number of overloaded finite elements (>3000 με) in the alveolar crest of
bone fully osseointegrated implant. This observation is in good agree-
ment with the aforementioned clinical findings. Furthermore, the present
study revealed that partially osseointegrated implants (Fig. 4b) might
cause implant failures due to excessive forces around the implant apex.
In this study, the stress intensity in the implants varied markedly
depending on the biomechanical conditions. For instance, the stress in-
tensity in the partially osseointegrated and buccolingually loaded
implant was approximately 100% higher than the stress intensity in the
fully osseointegrated implant using the same loading scenario. The large
differences in maximum stress values obtained from the fully osseoin-
tegrated and partially osseointegrated implant models demonstrate that
the stage of osseointegration has a significant effect on dental implant
performance. This factor becomes more apparent in combination with
unfavorable buccolingual loading. The results indicate that the cancel-
lous bone density is a less important factor in terms of structural per-
formance of the implant than the stage of osseointegration or loading
scenario.
In all cases, the most critical location in terms of stress intensity was
between the first and second thread, which is in accordance with ob-
servations of other authors [46,47]. In the case of the fully osseointe-
grated implants loaded by an inclined force (Case II), which can be
considered as the most common case in real life, the maximum stress
intensity was approx. 370 MPa. This value is in good agreement with the
results of Wang [46], who performed simulations under similar condi-
tions. However, only static loading was analyzed in our study. If a dy-
namic load was to be simulated, the maximum stress intensity could be
twice as high. In such a case, the stresses induced (represented by Case II)
could put the implant at risk, as these stresses are close to the yield limit
for titanium alloy (860 MPa [48]). Moreover, in situ, dental implants
undergo cyclic loadings; therefore, the fatigue life of the implants should
also be investigated. According to a study by Morgan et al. dental im-
plants very rarely exhibit fatigue failure under coronoapical loads [49].
This is in good agreement with the current study. However, the other
loading scenarios assessed in this study are much more critical regarding
cyclic mastication and might not withstand an infinite number of cycles,
as the stresses are above the endurance limit of the implant. Fig. 8b shows
that the stresses in the partially osseointegrated implant loaded bucco-
lingually are above the yield strength. This indicates that the implant's
reliability cannot be guaranteed even for a single load cycle in such a
case.
One drawback of this study was that only one implant type was used
for the assessments. Even though stress and strain evaluations generally
depend on geometrical specifics, the main observations and conclusions
regarding the effects of partial osseointegration can be expected to be
universal for any implant/bone system. Selection of other type or size of
screw implant would alter specific values of monitored stresses/strains.
However, the extremely detailed geometry of the trabecular structure
included in the model provides good insight into the qualitative implant-
induced force flow in peri-implant bone which is governed mainly by the
loading and osseointegration-based contact conditions.
5. Conclusion
It can be concluded that partial osseointegration is a potential risk in
terms of implant reliability. Unfavorable or adverse changes in trabecular
bone architecture due to bone remodeling might significantly affect
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Computers in Biology and Medicine 96 (2018) 157–165
biomechanical conditions in the oral cavity.
Author contributions statements
PM and JW wrote the main manuscript. JW and LB supervised the
research. LH contributed samples. JK and TZ performed micro-CT im-
ages. PM, LB and TZ performed FEA. All authors reviewed the
manuscript.
Conflicts of interest
None Declared.
Acknowledgements
The work was supported by the Czech Science Foundation by Grant
No. 16-08944S. This research has been financially supported by the
Ministry of Education, Youth and Sports of the Czech Republic under the
project CEITEC 2020 (LQ1601) of the National Sustainability Programme
II.
Appendix A. Supplementary data
Supplementary data related to this article can be found at https://doi.
org/10.1016/j.compbiomed.2018.03.012.
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