BIOMECHANICS OF DENTAL

IMPLANTS

CONTENTS
Introduction
Loads applied to dental implants
Mass, force and weight
Forces and components of forces
Three types of forces
Stress
Stress-strain relationship
Biting forces
Predicting forces on oral implants
Stiffness of teeth and implant
Models for predicting forces on prosthesis supported by
teeth and implants

 Force delivery and failure mechanism

Moment loads
Clinical moment arms
Fatigue failure
The biomechanical response to loading
A scientific rationale for dental implant design
Character of the applied forces
Functional surface area
Biomechanics of frameworks and misfit
Treatment planning based on biomechanical risk factors
Conclusion
List of reference

LOADS APPLIED TO DENTAL IMPLANTS

In function occlusal loads
Absence of function Perioral forces
Horizontal loads
Mechanics help to understand such physiologic and non
physiologic loads and can determine which t/t renders more risk.
MASS, FORCE AND WEIGHT
Mass A property of matter, is the degree of gravitational attraction
the body of matter experiences.
Unit kgs : (lbm)

FORCE (SIR ISAAC NEWTON 1687)

Newtons II law of motion
F = ma
Where a = 9.8 m/s2
Mass Determines magnitude of static load
Force Kilograms of force
WEIGHT
Is simply a term for the gravitational force acting on an
object at a specified location.

FORCES AND FORCE COMPONENTS

Magnitude, duration, direction, type and magnification
Vector quantities
Direction dramatic influence

Break down of 3D forces into their component parts vector resolution

Point of action of a vector
VECTOR

F/F

Magnitude F

F = 44.5 N at pt B
Not || to direction of long axis of implant
Analysis - vector resolution
Co-ordinate system
Angles that the F vector makes with co-ordinate axes,
resolution of F into its 3 components is possible
i.e. Fx, Fy & Fz
F=

F2x + F2y + F2z

Cos2x + Cos2 y + Cos2 z = 1

Lateral as well as vertical components are acting at the same
time

Vector addition : More than one force

FR = F1 + F2 + F3

MOMENT / TORQUE
Tend to rotate a body

Units N.m; N.cm, lb.ft ; oz.in

Eg :

In addition to axial force, there is a moment on the implant which is

equal to magnitude of force times (multiplied by) the perpendicular
distance (d) between the line of action of the F and center of the
implant

THREE TYPES OF FORCES

Compressive
Tend to push masses towards each other
Maintains integrity of bone implant interface
Accommodated best
Cortical bone strongest in Comp
Cements, retention screws, implant components and bone
implant interfaces well acc Comp F
Dominant

Tensile

Shear

Pull object apart

Sliding

Distract / disrupt bone implant interface

Shear most destructive, cortical bone is weakest

Cylinder implants

highest risk for shear forces

require coating

Threaded / finned implants

Impart all 3 force types
Geometry of implant

STRESS
The manner in which a force is distributed over a surface is
referred as mechanical stress
= F/A
Even distribution of mechanical stress in the implant system and
contiguous bone
Force magnitude

Reducing magnifiers of force

1. Cantilever length
2. Crown height
3. Night guards
4. Occlusal material
5. Overdentures

Functional cross sectional area

1. Number of implants
2. Implant geometry

DEFORMATION & STRAIN

Implant
Tissue
Deformation and stiffness of implant material
Applied load deformation

Interface
Ease of implant manufacture
Clinical longevity
Concept of strain key mediator of bone activity

Strain = deformation per unit length

STRESS STRAIN RELATIONSHIP

Load versus deformation curve; stress - strain curve
Prediction of amount of strain experienced by the material under
an applied load.
Modulus of elasticity
tnalpmI | biologic tissue

Lesser the relative motion

In stress

In stiffness difference

Relative motion

Interface is more affected

Viscoelastic bone can stay in contact

with more rigid titanium more
predictably when the stress is low

STRAIN
Controlling applied stress

Changing density of bone

Strength Stiffness

Greater the strength stiffer the bone

Lesser the stiffness greater the flexibility (soft bone)
Difference in stiffness is less for CpTi & D1 bone but more for D4
bone
Stress reduction in such softer bone
To reduce resultant tissue strain
Ultimate strength
Hooks law
Stress = Modulus of elasticity x strain

BITING FORCES
Axial component of biting forces : (100 2500 N) / (27 550 lbs)
It tends to increase as one moves distally

Lateral component - 20 N (approx.)

Net chewing time per meal = 450 sec
Chewing forces will act on teeth for = 9 min/day
If includes swallowing = 17.5 min/day
Further be increased by parafunction

Provides minimum time /day that teeth (implants) are bearing load
due to mastication and related events

PREDICTING FORCES ON ORAL IMPLANTS

Problems :
To compute the loading on the individual supporting abutment
More than two implant supporting prosthesis
COMPLICATING FACTORS
Nature of mastication

Nature of Prosthesis

Properties

Chewing frequency
sequence

Full / partial

Elastic moduli

Tissue supported

Stiffness

Biting strength
favoured side
Mandibular movements

Vs
Implant supported
No. & location
Angulation

Connection
Deformability

Two implants supporting a cantilever portion of a prosthesis

P = Force
a = Cantilever length
b = Dist. Between two implants

If beam is in static equilibrium sum of forces and sum of

moments are zero.
Fy = 0 ; -F1 + F2 P = 0 mQ = 0; -F1b + Pa = 0
Here, F1 = (a/b)P
F2 = (1 + a/b) P
In most clinical situations a/b = 2.
So, F1 = 2P and F2 = 3P
Newtons 3rd law of motion
Implant 2 compressive load

Implant 1 tensile load

FOUR IMPLANTS SUPPORTING A FRAMEWORK

(BRANEMARK SYSTEM)

LIMITATIONS
1. Does not predict forces on all 4 implants
2. Overestimation of loads
3. Based on theory of rigid body statics
Skalak model
Can predict the vertical and horizontal force components on
implants supporting a bridge

 Bridge and bone are rigid

Implants and/or their connections to bridge and/or bone elastic
Purely vertical force

Purely horizontal force

Counterbalanced by distribution of N no. of implants so, there

will be both vertical and horizontal forces on each implant

 4 or 6 implant symmetrically distributed in the arc of 112.5 0

with radius of mandible at 22.5 mm
Arc of 112.50 = interforaminal dist. (approx)
Single vertical force of 30N acts at a position defined by = 100
(So, how to predict the vertical forces on each implant)

F< 30 N

Magnitude of force is |||

 Forces on remaining 4 implants become much larger than in

original 6 implant case
Condition can be worsened if 4 implants are placed in a line across
the anterior mandible.
As, ratio a/b is very large as b (interimplant distance) is very
small.
Implant angulation.

 Implant 1 at 300 angulation.

Offaxis loading detrimental to the system.
Cannot be solved by Skalak or Rangert model.
Finite element modelling or analysis.
Properties of the prosthesis
Positioning and angulation of implants
Properties of interfacial bone can be accounted to FE

Skalak modle
Prosthesis is infinitely rigid
Acrylic and metal alloy bridge flexible

Concentrating forces on the implants nearest to loading point

Unequal stiffnesses
Stiffest implant will generally take up most of the load

STIFFNESS OF TOOTH AND IMPLANT

Prosthesis supported by teeth and implants.
Neither Rangert nor Skalak model specifically deal with
differencing mobility
A way to approach this problem is
1. Displacement in any direction
Unidirectional force but displacement in many direction
Secondary effect
2. Application of constant force
Increase in displacement slowly with time

Creep
Not significant with implants
3. Intrusive tooth displacement is not always Linear
usually bilinear
4. Net stiffness > natural tooth

PROSTHESIS SUPPORTED BY TEETH AND IMPLANTS

Use of FEA
Concept of IME
eg: F = 100 N
Natural tooth = 30% when paired with an implant without IME
= 38% when IME is incorporated
Rationale for use of IME
Effectiveness in clinical situations have to be checked
Rangert et al
Equal sharing of forces by tooth and implant so, need for IME
in an osseointegrated implant is questionable.

FORCE DELIVERY AND FAILURE MECHANISM

Manner of application of force
Moment loads
Interface breakdown
Bone resorption
Screw loosening
Bar / bridge fracture

Clinical moment arms

1) Occlusal height
Mesiodistal axis

Faciolingual axis

Working and balancing occlusal contacts

Tongue thrusts, perioral musculature
Force component along vertical axis no effect

Initial moment load at crest

In div A

Div C and D
Crown height

2) Cantilever length
Vertical axis force components
Lingual force component
Force applied directly over the implant
4 or 6 implant case
Exact cantilever length
2-3 premolars
6 instead of 4 implants
A-P spread
A-P spread the resultant load

MISCH
Amount of stress applied to system
Generally
Distal cantilever not be > 2.5 times of A-P spread
Patients with parafunction not to be restored by cantilever
Square arch form - A-P spread - cantilever
Tapered arch form largest A-P spread largest cantilever
design.

OCCLUSAL WIDTH
Moment arm for any offset occlusal load
Narrow occlusal table - faciolingual tipping
Moment loads

Crestal bone loss

Failure if biomechanical
environment is not
corrected
More crestal bone loss

Increases occlusal height

Occlusal ht. moment arm

Faciolingual micro
rotation or rocking

FATIGUE FAILURE
Dynamic cyclic loading condition
1) Biomaterials
A plot of applied stress vs no. of loading cycles
High stress few loading cycles
Low stress infinite loading cycles
Endurance limit
Ti alloy > CpTi.
2) Geometry
Resists bending and torque
Lateral loads fatigue fracture
4th power of the thickness difference
Inner and outer diameter of screw and abutment screw space

3) Force magnitude
Reduction of applied load - (stress)
Higher loads on posteriors
Moment loads
Geometry for functional area
No. of implants
4) Loading cycles
No. of loading cycles
Elimination of parafunction
Reduce occlusal contacts

BIOMECHANICAL RESPONSE TO LOADING

High degree of variation as a function of load direction, rate and
duration
Direction of load
Orthotropic

Isotropic

Transversely isotropic

Mandible Arch of it having stiffest direction orientation

Long bone molded into a curve beam
Primary loads = occlusal ? Flexural
Inferior border more compact bone
Inter forminal part increase quality of trabecular bone

RATE OF LOADING
McElhaney strain rate dependence
Higher strain rate stiffer and stronger
Bone fails at higher strain rate, but with less allowable
elongation
Brittle
Duration of loading
Carter and Caler
Creep (time-dependent loading) + cyclic / fatigue loading
Anatomic location and structural density also has got influence

ANATOMIC LOCATION
Edentulous mandible Trabecular bone continuous with cortical
shell
FEM cortical bone dissipation of occlusal loads
Attention to trabecular bone mechanical properties
Muscle loads on mandible Dorsoventral shear, twisting,
transverse
Anterior mandible large moment loads buccolingal flexure
Posterior mandible higher bite force
Density and ultimate compressive strength ()
Large, multirooted molars

Qu et al 65% higher stiffness for trabecular bone of mandible

when bounded by cortical plates
Structural density
Qu et al Mechanical properties of mandibular trabecular bone
I.e. Elastic modulus and ultimate strength.
47% - 68% > in anterior compared to posterior
Premolars = molars.

Scientific rationale for dental implant design

Transfer of load to surrounding biologic tissue. Two factors are
1) Character of applied load 2) Functional surface area
Character of forces applied to dental implant
Magnitude, duration, type, direction and magnification

FORCE MAGNITUDE
A) Physiology vs design :
Limits magnitude of force for a engineered design
Function of anatomic region and state of dentition
Parafunction >
1000 lb
density

Molar
200 lb

forces

>

Canine >

Incisors

100 lb

25-35 lb

B) Biomaterial selection :
Silicone, HA, carbon High biocompatibility
Low ultimate strength
Titanium and its alloy Excellent biocompatibility
Corrosion resistance
Good ultimate strength
Closest approx. to stiffness of bone
6 times more stiff
C) Failures :
Vitreous carbon implant

Al2O3 ceramic implant

Modulus of elasticity
Ultimate strength

Ultimate strength
Modulus of elasticity

FORCE DURATION
A) Physiology vs design
Duration of bite force
Ideal condition < 30 min/day
Parafunction several hours
B) Implant body design
Endurance limit 1 times < ultimate tensile strength
Fatigue more critical especially in parafunction
Off axis, cyclic loading
Bending loads in buccolingal plane
Root form implant not specifically designed to withstand
cyclic bending loads.

 Components moment of inertia

Apical extension of the abutment screw within the implant
body
Crest-module around an abutment screw
(ODR)4 (IDR)4
Small in wall thickness is significant
OD by 0.1 mm 33% in strength
ID by 0.1 mm 20% in strength
Prosthesis / coping screw moment of inertia
Screw breakage long term advantage
Failure Morgan et al

FORCE TYPE
A) Physiology
Bone

Strongest in compression
30% weaker in tensile
65% weaker in shear

Endosteal root-form implants pure shear

Incorporation of surface features
B) Implant body design
Titanium / HA
Shear strength of HA-to-bone bond

THREADED IMPLANTS

V-shaped

Buttress

Buttress comparable to V-shaped

V-shaped 10 times greater shear (square / power)
Caution in D3 and D4 bone
Failure
Smooth shear surface inadequate load transfer

Square

FORCE DIRECTION
A) Physiology
Positioning of root form implants suitable for axial loading
Undercuts further limit
Usually occur on facial aspect except
Submandibular fossa
Angled to the lingual
Bone is strongest when loaded along its long axis.
300 offset load :

11% compressive
25% tensile

B) Implant body design

Vulnerable crestal bone region

FORCE MAGNIFICATION
Extreme angulation
Parafucntion

Exceeds the capability of any

dental implant

Cantilevers and crown heights levers

Indication for functional surface area
Density strength
D4 bone 10 times weaker than D1 bone
Thus resultant force will be magnified when placed in softer
bone

SURFACE AREA
Normal anatomy limits size and configuration
Bone volume (external architecture)
Anatomic location and degree of bone resorption
Width :

6-8 mm in anterior 4 mm implant

> 7 mm in posteriors 5 mm implants

Implant width anterior to posterior

Height :
Anterior mandible > anterior maxilla > post mandible > post maxilla
Hence, occlusal forces in bone height
Bone quality (internal architecture)
35% failure rate in D4 bone
Poor quality, porous bone - ed clinical failure
No. of implants, design with greater surface area

SURFACE AREA OPTIMIZATION

Implant macrogeometry :
Smooth sided cylindrical implants
Ease in surgical placement
Greater shear at interface
Smooth sided tapered implants
Component of compressive force Taper
Taper < 300
Threaded implants
Ease of surgical placement
Greater functional surface area compressive loads
Limits micro-movement during healing

IMPLANT WIDTH
Branemark 3.75 mm
Implant width - functional surface area
4 mm implant 33% greater surface area
Diameter appropriate to ridge width
Teeth 6 12 mm
Similar implant width bending resistance inadequate
strain to bone resorption
Crestal bone anatomy less than 5.5 mm

THREAD GEOMETRY
Parameters thread pitch, shape and depth
Thread pitch
Number of threads per unit length
Fine pitch threads surface area / unit length
Fewer threads easy to bone tap

Thread shape
V-thread design fixture fixating metal parts and not for load
transfer
Buttress thread pullout loads
Dental implants load transmission intrusive
Square / power thread

Thread depth
= Major diameter minor diameter
Conventional implant uniform
Can be varied in the region of highest stress
Reverse taper in minor diameter

Increased depth

Dramatic in functional surface area

IMPLANT LENGTH
Length - total surface area
Bicortical stabilization
Eg: Anterior mandible adequate height, greater density and less
occlusal forces
Simply does not need longer implant
D3 and D4 bone posterior region, less available bone
Need for nerve repositioning mandible
Sinus graft

maxilla

Does not benefit the primary regions of increased stress

crestal bone region
Greater stability under lateral loading
Not necessarily better
Minimum implant length

CREST MODULE CONSIDERATIONS

Transosteal region from the implant body and characterized as
a region of highly concentrated mechanical stress
Not ideally designed for stress
Smooth parallel sided crest module shear
Angled crest module ( > 200) surface texture
Slightly larger than outer diameter 4 reasons
Polished collar (0.5 mm) perigingival area
Longer polished collar shear loading crestal bone loss
Bone is often lost to first thread

APICAL DESIGN CONSIDERATION

Most root form implants circular
Do not resist torsional / shear forces (single tooth implant)
Antirotational feature hole or vent
Advantages
Bone can grow in and resist
torsional forces
Increases surface area

Disadvantages
May fill with mucus or
fibrous tissue

Flat sides or grooves along the body or apical region

Apical end should be flat instead of pointed

BIOMECHANICS OF FRAMEWORKS AND MISFIT

Frameworks :
Metal framework for full arch prosthesis can fracture
More towards the cantilever section
Reasons :
1) Overload of cantilever
Unlikely to occur typical prosthetic alloy.
2) Metallurgic fatigue under cyclic loads
Prevention substantial cross sectional area
3-6 mm

GOLD SCREWS AND ABUTMENT SCREWS

Metal framework is held onto the abutments by screw joints,
in which gold screw is torqued into the abutment screw.
Screw joints main function is to clamp the gold cylinder and
attached framework onto the abutment cylinder.
Tensile force on gold screw and abutment screw &
compressive clamping force on titanium abutment cylinder.
Two forces are equal and opposite desired situation.
Joint clamping force is called preload.
External applied force > preload = opening of screw joint.

FRAMEWORK MISFIT
Inevitable dimensional
inaccuracies
Passive fit
Misfitting framework can
cause loads on implant even
before any bitting force is
applied

TREATMENT PLANNING BASED ON BIOMECHANICAL

RISK FACTORS
Design of final prosthetic reconstruction
Anatomical limitation
Geometric risk factor
1) No. of implants less than no. of root support
One implant replacing a molar risk.
1 wide plat from implant / 2 regular implants
Two implants supporting 3 roots or more risk
2 wide platform implants
2) Wide platform implants
Risk if used in very dense bone
3) Implant connected to natural teeth

4) Implants placed in a tripod configuration

Desired counteract lateral loads
5) Presence of prosthetic extension
6) Implants placed offset to the center of the prosthesis in tripod
arrangement, offset is favorable
7) Excessive height of the restoration

OCCLUSAL RISK FACTORS

Force intensity and parafunctional habit
Presence of lateral occlusal contact
Centric contact in light occlusion
Lateral contact in heavy occlusion
Contact at central fossa
Low inclination of cusp
Reduced size of occlusal table

BONE IMPLANT RISK FACTORS

Dependence on newly formed bone
Absence of good initial stability
Smaller implant diameter
Proper healing time before loading
4 mm diameter minimum posteriors

Technological risk factors

Lack of prosthetic fit and cemented prostheses
Proven and standardized protocols
Premachined components
Instrument with stable and predefined tightening torque

WARNING SINGS
Repeated loosening of prosthetic / abutment screw
Repeated fracture of veneering material
Fracture of prosthetic / abutment screws
Bone resorption bellow the first thread

LIST OF REFERENCES
Dental implant prosthetics Carl E. Misch.
Esthetic implant dentistry Patric Palacci.
Osseointegration in oral rehabilitation Naert et al.
Principles and practice of implant dentistry Charles Weiss,
Adam Weiss.
Tissue integrated prosthesis. Osseointegration in clinical
dentistry Branemark, zarb, Albrektsson
Implant & restorative dentistry Gerard M. Scortecci
Implant dentistry 2000; 9 (3) : 207-218.
JPD 2002 ; 88 : 604-10.
IJOMI 1992 ; 7 : 450-58.
JPD 2000 ; 83 : 450-55.

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