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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 section has been regarded as symmetrical to the
mandibular molar region was modeled for finite element stress plane in Fig. 1, which allowed modeling of only one of the
analysis. The distributions of stresses in the bone around the symmetrical halves, with the other half simulated by appro-
implant due to axial and transverse loading were calculated for priate boundary conditions. The slight curvature of the
different stages of normal and pathological development of the mandible in the anterior-posterior direction has been
implant-bone interface. Highest stress concentrations are observed in neglected for ease of modeling.
the crestal region with transverse loading when spongy bone sur- Four possible stages of implant-bone interface develop-
rounds the implant immediately after surgery. Development of a
lamina dura around the implant slightly reduces severe stress peaks, ment (Fig. 3) were simulated in the model by varying
whereas ingrowth of connective tissue almost eliminates them. input data for the mechanical properties of the layers in the
interface region shown in Fig. 2b. In Fig. 3, model con-
J Dent Res 62(2):155-159, February 1983 figuration A represents the situation immediately after
implantation, when the implant is totally surrounded by
Introduction. cancellous bone. Brinkmann2 observed development of a
cortical bone-like lamina dura around the implant in about
Anchor-type endosteal implants made of aluminum oxide 50% of all cases of successful implantation. This situation is
ceramic (Al203-ceramic) were used to replace teeth in the represented by configuration B. Proliferation of connective
molar region of the mandible.1 The occasional clinical and tissue into the gap between implant and spongy bone,
experimental failures of this type of implant were partly due increasing implant mobility and causing subsequent
to connective tissue formation at the implant-bone inter- failure,3'9 is reflected in configuration C. Finally, it might
face2-3 and showed the need for a detailed stress analysis. happen that, after successful implantation and formation of
Since the finite element method (FEM) has proved to be a a lamina dura, connective tissue migrates along the implant
useful tool in estimating stresses around implants of stem as represented by configuration D.
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 ling
from such a study will improve the understanding of the
mechanisms of tissue reaction and failure in endosteal
dental implantation.
In the model, the tissues and ceramic were regarded as implant's crown; and second, in the lingual direction,
homogeneous, isotropic, and linearly elastic materials. Their perpendicular to the crown's axis. For convenient com-
mechanical properties listed in the Table were selected from parison of the results, and due to lack of data in the litera-
the literature. No slip between the implant and surrounding ture, the forces were taken as equal in both cases, even
tissue was allowed to occur in the model. though the lateral forces are most probably smaller in
Two load cases were taken into account for each of the reality. Force was applied at the top center node of the
four model configurations. A force of 200 N was chosen to implant crown. The reaction force was generated by con-
act: first, occlusally, i.e., parallel to the axis of the 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
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
LOCATION [mFAN
15 20 25 30
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 159
3. Further analysis should be done to evaluate design Simon, B.R., Ed., Tucson: The University of Arizona, 1980,
improvements in order to increase the share of load pp. 169-178.
transmitted by the implant wings, thus unburdening the 6. LAVERNIA, C.J.; COOK, S.D.; KLAWITTER, J.J.; WEIN-
stem region. STEIN, A.M.; and DAS, S.C.: The Effect of Implant Elastic
Modulus on the Stress Distribution Surrounding Dental
Implants. In: International Conference Proceedings, Finite
Acknowledgments. Elements in Biomechanics, Simon, B.R., Ed., Tucson: The
University of Arizona, 1980, pp. 179-182.
Calculations in this study were carried out with the 7. ZIENKIEWICZ, O.C.: The Finite Element Method in
support of the Regional Computation Center for Lower Engineering Science, London: McGraw-Hill, 1971, pp. 1-102.
Saxony at the University of Hannover (RRZN). We wish to 8. BATHE, K.J.; WILSON, E.L.; and PETERSON, F.E.: SAP
thank Mrs. Katharina Schmidt for her help with the data IV - A Structural Analysis Program for Static and Dynamic
preparation and illustrations. Analysis of Linear Structural Systems. In: EERC Report No.
73-11, Berkeley: The University of California, June, 1973,
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