Mehmet Emin TOPRAK

Sloped marginal configuration design of implants as an alternative innovation to the grafting operations: a three-dimensional finite element analysis

Anahtar Kelimeler:

Dental implant design, grafting, sloped marginal configuration, innovation, biomechanics

Sloped marginal configuration design of implants as an alternative innovation to the grafting operations: a three-dimensional finite element analysis

Aim: Dental implant operations often require bone grafting due to bone resorption in the buccal area, which make the treatment more complicated, increase the risk of complications, and results in extra costs and prolongation of treatment. This study aimed to evaluate the biomechanical behavior of the implants with a sloped marginal configuration design in the alveolar ridge with a level difference between the buccal and lingual bone levels using three-dimensional finite element analysis (FEA) method. Material and Method: Two implant models with different marginal configuration designs were used in this study. Implants were placed in the posterior edentulous mandible models in which the buccal region had a 2 mm more resorption according to lingual region which were created by imitating natural bone resorption with FEA. Bone grafting was performed on the exposed buccal surface in the conventional flat marginal configuration implant model (Model 1). In contrast, the sloped marginal configuration implants were compatible with the difference in bone level and placed directly without any additional surgical procedures (Model 2). Than three unit fixed partial dentures were designed. The design of cortical and cancellous bones, prosthetic components, implants, abutment screws and abutments covering those in the edentulous mandible models were transferred to digital three-dimensional models that were created to mimicking the real structures. The models were fixed below and behind of the mandible with zero movement. Load transfer characteristics of both models under these essential limitations were evaluated under 200N foodstuff force. Results: The highest von Mises stress value was observed as 69.300 MPa in Model 1 and 126.870 MPa in Model 2. The maximum principal stress values were 28.236 N/mm2 and 63.449 N/mm2; the minimum principal stress values were 38.346 N/mm2 and 43.643 N/mm2 in Model 1 and Model 2, respectively. The highest von Mises stress value, maximum principal stress and minimum principal stress values were found higher in Model 2 which was created with sloped marginal configuration design of implants but all values were observed within acceptable physiological limits. Conclusion: The sloped marginal configuration design of implants can be a non-invasive and more economical treatment alternative modality compared to conventional flat marginal configuration implants with advanced surgeries during implant placement.

Keywords:

Dental implant design, grafting, sloped marginal configuration, innovation, biomechanics,

PDF

___

Steigenga JT, Al-Shammari KF, Nociti FH, Misch CE, Wang H-L. Dental implant design and its relationship to long-term implant success. Imp Dent 2003; 12: 306-17.
Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Imp 2004;19: 7.
Ozan O, Kurtulmus-Yilmaz S. Biomechanical comparison of different implant inclinations and cantilever lengths in all-on-4 treatment concept by three-dimensional finite element analysis. Int J Oral Maxillofac Imp 2018; 33: 1.
Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. J Prosthet Dent 1967; 17: 21-7.
Cawood J, Howell R. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988; 17: 232-6.
Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Perio Rest Dent 2003; 23: 4.
Noelken R, Donati M, Fiorellini J, et al. Soft and hard tissue alterations around implants placed in an alveolar ridge with a sloped configuration. Clin Oral Imp Res 2014; 25: 3-9.
Welander M, Abrahamsson I, Berglundh T. Placement of two‐part implants in sites with different buccal and lingual bone heights. J Periodontol 2009; 80: 324-9.
Abrahamsson I, Welander M, Linder E, Berglundh T. Healing at implants placed in an alveolar ridge with a sloped configuration: an experimental study in dogs. Clin Imp Dent Relat Res 2014; 16: 62-9.
Wöhrle PS. Nobel perfect™ esthetic scalloped implant: rationale for a new design. Clin Imp Dent Relat Res 2003; 5: 64-73.
Geng J-P, Tan KB, Liu G-R. Application of finite element analysis in implant dentistry: a review of the literature. J Prosthet Dent 2001; 85: 585-98.
Alvarez-Arenal A, Gonzalez-Gonzalez I, deLlanos-Lanchares H, Brizuela-Velasco A, Ellacuria-Echebarria J. Influence of implant positions and occlusal forces on peri-implant bone stress in mandibular two-implant overdentures: a 3-dimensional finite element analysis. J Oral Implantol 2017; 43: 419-28.
Kilic E, Doganay O. Evaluation of stress in tilted implant concept with variable diameters in the atrophic mandible: three-dimensional finite element analysis. J Oral Implantol 2020; 46: 19-26.
Karasan D, Güncü MB, Ersu B, Canay Ş. Biomechanical behavior of implants with a sloped marginal configuration. Int J Prosthodontics 2018; 31: 587-90.
Grandin HM, Berner S, Dard M. A review of titanium zirconium (TiZr) alloys for use in endosseous dental implants. Materials 2012; 5: 1348-60.
Akça K, Eser A, Çavuşoğlu Y, Sağırkaya E, Çehreli MC. Numerical assessment of bone remodeling around conventionally and early loaded titanium and titanium–zirconium alloy dental implants. Med Bio Eng Comput 2015; 53: 453-62.
Mosavar A, Ziaei A, Kadkhodaei M. The effect of implant thread design on stress distribution in anisotropic bone with different osseointegration conditions: a finite element analysis. Int J Oral Maxillofac 2015; 30: 6.
Inglam S, Suebnukarn S, Tharanon W, Apatananon T, Sitthiseripratip K. Influence of graft quality and marginal bone loss on implants placed in maxillary grafted sinus: a finite element study. Med Bio Eng Comput 2010; 48: 681-9.
Toth A, Hasan I, Bourauel C, et al. The influence of implant body and thread design of mini dental implants on the loading of surrounding bone: a finite element analysis. Biomed Eng 2017; 62: 393-405.
Soğanci G, Yazicioğlu H. Evaluation of stress distribution of mini dental implant-supported overdentures in complete cleft palate models: a three-dimensional finite element analysis study. Cleft Palate Craniofac J 2016; 53: 73-83.
Noelken R, Oberhansl F, Kunkel M, Wagner W. Immediately provisionalized OsseoSpeed™ profile implants inserted into extraction sockets: 3‐year results. Clin Oral Imp Res 2016; 27: 744-9.
Schiegnitz E, Noelken R, Moergel M, Berres M, Wagner W. Survival and tissue maintenance of an implant with a sloped configurated shoulder in the posterior mandible—a prospective multicenter study. Clin Oral Imp Res 2017; 28: 721-6.
Jaffin RA, Berman CL. The excessive loss of Branemark fixtures in type IV bone: a 5‐year analysis. J Periodontol 1991; 62: 2-4.
Lee J-H, Frias V, Lee K-W, Wright RF. Effect of implant size and shape on implant success rates: a literature review. J Prosthet Dent 2005; 94: 377-81.
Blanes RJ, Bernard JP, Blanes ZM, Belser UC. A 10‐year prospective study of ITI dental implants placed in the posterior region. II: Influence of the crown‐to‐implant ratio and different prosthetic treatment modalities on crestal bone loss. Clin Oral Imp Res 2007; 18 :707-14.
Bozkaya D, Muftu S, Muftu A. Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite elements analysis. J Prosthet Dent 2004; 92: 523-30.
Kaleli N, Sarac D, Külünk S, Öztürk Ö. Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional finite element analysis study. J Prosthet Dent 2018; 119: 437-45.
Lian Z, Guan H, Ivanovski S, et al. Effect of bone to implant contact percentage on bone remodelling surrounding a dental implant. Int J Oral Maxillofac Surg 2010; 39: 690-8.