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Finite Element Analysis, Stress, Mechanical, Biomechanical Phenomena, Bite Force, Dental Stress Analysis methods, Computer Simulation, Dental Prosthesis Design, and Dental Implants

Statement of Problem: The clinical application of short implants has been increasing. However, studies on the marginal bone loss of short implants are sparse, and clinicians often choose short implants based on their own experience rather than on scientific information.
Purpose: The purpose of this finite element analysis study was to evaluate the microstrain-stress distribution in the peri-implant bone and implant components for 4 types of short implants at different placement depths of platform switching.
Material and Methods: By using short implants as prototypes, 4 short implant models were 1:1 modeled. The diameter and length of the implants were 5×5, 5×6, 6×5, and 6×6 mm. The restoration was identical for all implants. Three different depths of implant platform switching were set: equicrestal, 0.5-mm subcrestal, and 1-mm subcrestal. The models were then assembled and assigned an occlusal force of 200 N (vertical or 30-degree oblique). A finite element analysis was carried out to evaluate the maximum equivalent elastic strain and von Mises stress in the bone and the stress distribution in the implant components.
Results: The 5×5 implant group showed the largest intraosseous strain (21.921×10 3 με). A 1-mm increase in implant diameter resulted in a 17.1% to 37.4% reduction in maximum intraosseous strain when loaded with oblique forces. The strain in the bone tended to be much smaller than the placement depth at the equicrestal and 0.5-mm subcrestal positions than that at the 1-mm subcrestal position, especially under oblique force loading, with an increase of approximately 37.4% to 81.8%. In addition, when the cortical bone thickness was less than 4 mm, 5×6 implants caused significantly higher intraosseous stresses than 6×6 implants.
Conclusions: Large implant diameters, rather than long implants, led to reduced intraosseous strain, especially under oblique loading. Regarding the implant platform switching depth, the short implant showed small intraosseous strains when the platform switching depth was equicrestal or 0.5-mm subcrestal.
(Copyright © 2023 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Stress, Mechanical, Computer Simulation, Finite Element Analysis, Biomechanical Phenomena, Dental Stress Analysis methods, and Dental Implants

Purpose: To compare and evaluate density changes in alveolar bones and biomechanical responses including stress/strain distributions around customized root implants (CRIs), traditional implants, and natural teeth.
Materials and Methods: A three-dimensional finite element model of the maxillary dentition defect, CRI models, traditional restored implant models, and natural teeth with periodontal tissue models were established. The chewing load of the central incisor, the traditional implant, and the CRI was 100N, and the load direction was inclined by 11° in the sagittal plane. According to the bone remodeling numerical algorithm, the bone mineral density and distribution were calculated and predicted. In addition, animal experiments were performed to verify the feasibility of the implant design. The results of the simulation calculations were compared with animal experimental data in vivo to verify their validity.
Results: No significant differences in bone mineral density and stress/strain distribution were found between the CRI and traditional implant models. The animal experimental results (X-ray images and histological staining) were consistent with the numerical simulated results.
Conclusions: CRIs were more similar to traditional implants than to natural teeth in terms of biomechanical and biological evaluation. Considering the convenience of clinical application, this biomechanical evaluation provides basic theoretical support for further applications of CRI.
(© 2022 by the American College of Prosthodontists.)

Ceramics, Dental Stress Analysis methods, Friction, Materials Testing, Orthodontic Appliance Design, Orthodontic Wires, Stainless Steel, and Orthodontic Brackets

Objective: The main objective of our study was to compare a new model of self-ligating ceramic bracket (Clarity™ Ultra by 3M™), to its competitors by evaluating their resistance to sliding during an in vitro simulation of canine retraction.
Material and Methods: The sample consisted of 120 brackets (30 brackets in each group: Victory Twin Series LP™, Clarity Ultra™ by 3M™, Damon Clear 2™ by Ormco™ and Empower™ 2 Clear by American Orthodontics™). Canine retraction was simulated using a universal testing machine connected to a software that measured the average sliding resistance (ASR) for each group. Five brackets from each group were randomly selected and observed under a digital optical microscope at ×50 magnification. ANOVA test and Tukey's analysis were carried to detect statistically significant differences between the groups' sliding resistance values, at the risk of α=0.05.
Results: Measured ASR values of control group (metallic Victory Twin) were the highest ones (70.55g), followed by 3M™ (33.22g) then Damon™ (6.72g) and AO™ (5.49g) (P-value<0.0001). Through microscopic observations, we found that the 3M™ bracket has the lowest percentage of slot chamfering (8%) compared to the other brackets (12%). The 3M™ bracket also has the widest slot followed by AO, and then Damon™. All three bracket types have oversized slots compared to the manufacturer's description, the least oversized being the 3M™ bracket, followed by AO™ and then Damon™. 3M™ and Damon™ brackets have covers that concealed the entire wire in the vertical dimension whereas the AO™ bracket has a curvilinear cover that only shields the gingival part of its slot. Wire-play is zero for the 3M™ group, and 0.1mm for the other two groups.
Conclusion: Clarity Ultra™ ceramic bracket produced by 3M™ does not perform well against friction forces compared to its competitors and that is due to its micro-morphological characteristics.
(Copyright © 2022 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Dental Abutments, Dental Stress Analysis methods, Torque, Bone Screws, Dental Implant-Abutment Design, and Dental Implants

Statement of Problem: Information regarding the rotational freedom of internal connection implants is sparse.
Purpose: The purpose of this in vitro study was to compare the rotational freedom of different internal conical and internal nonconical connections.
Material and Methods: Thirty implants, 30 straight manufactured standard abutments, and 30 standard abutment screws were obtained for each of the 5 implant systems tested. Three implant systems had indexed internal conical connections with different antirotational geometries: hexagon (Naturall+), cam-groove (ID CAM M), and octagon (Bone Level). Two implant systems had internal nonconical connections with hexagonal antirotational geometry (Tapered Screw-Vent and Seven). The implants were mounted in a steel plate, and a metal reference arm was attached to the abutment. Before tightening the standard abutment screw, a modified torque wrench was used to rotate the abutment clockwise until reaching the clockwise rotational endpoint. This modified torque wrench was connected to the abutment's outer surface. It allowed free access to the standard abutment screw for a second torque wrench, specific to each implant system. The modified torque wrench applied a controlled torque of 5 Ncm, which held the abutment at the clockwise rotational endpoint. The standard abutment screw was then tightened to the manufacturer's specified torque value with the second torque wrench. Angle value corresponding to the clockwise endpoint was measured microscopically between a fixed reference point on the steel plate and the reference arm. The abutment was then unscrewed and removed. The same procedure was carried out to rotate the abutment counterclockwise and measure the angle value corresponding to the counterclockwise rotational endpoint. The rotational freedom was finally determined from the differences in the angles between the clockwise and counterclockwise rotational endpoints. Rotational freedom angle values were summarized as descriptive statistics (means, standard deviations). The normality test (Kolmogorov-Smirnov) was applied, and the Kruskal-Wallis test was performed. The Wilcoxon signed-rank test was used to isolate the implant system differences from each other (α=.05).
Results: The lowest mean rotational freedom angles were obtained for Bone Level (conical connection, 0.17 degrees) and Tapered Screw-Vent (nonconical connection, 0.05 degrees). These systems were followed in increasing order by ID CAM M (conical connection, 0.50 degrees), Seven (nonconical connection, 1.98 degrees), and Naturall+ (conical connection, 2.49 degrees). Compared with each other, all implant systems had significant statistical differences in rotational freedom angles (P<.05).
Conclusions: Significant differences were found among the 5 implant systems. The lowest mean rotational freedom angles were obtained both with a conical connection (Bone Level) and a nonconical connection (Tapered Screw-Vent).
(Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Software, Prosthesis Design, Bite Force, Dental Prosthesis, Implant-Supported, Dental Stress Analysis methods, Dental Prosthesis Design, and Dental Implants

The prosthesis loading force is an important factor for dental implant survival. Even if adequate osseointegration of the dental implant has been achieved, if the occlusal forces are not correctly distributed, lateral torque can be generated causing high stress on surrounding tissues. The stress value of implant prostheses could be different whether the direction of load is vertical or oblique, affected by the shape of the occlusal surface. When an implant-supported prosthesis is designed with a dental computer-aided design software program, the average vectors from each occlusal contact point can be visualized. If the visualized vector generates lateral torque, the occlusal surface design can be modified before finalizing the design. The described technique uses automated vector analysis to enable visualization of the occlusal vector to improve prosthesis design, optimizing occlusal forces.
(Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Finite Element Analysis, Stress, Mechanical, Denture, Partial, Fixed, Tomography, X-Ray Computed, Dental Prosthesis, Implant-Supported, Dental Stress Analysis methods, and Dental Implants

The aim of this study is to evaluate the effectiveness of the implant diameter and length on force dissemination of tooth-implant and implant retained fixed restorations. A finite analysis model was used via a 3D simulation of a unilateral mandibular Kennedy Class I arch. Through thresholding the resultant assembly, a region of interest was selected from the computed tomography (CT) scan. Details of the diameter (D) and length (L) of implant were introduced. Ds used were 3.7, 4.7, and 5.7, while Ls used were 10, 11.5, and 13. The constant was the use of rigid connectors in both designs (implant-implant and implant-tooth fixed partial dentures [FPDs]) and the mesial implant (D 3.7 and L 11.5). Stress in cancellous bone around mesial abutment, which is the second premolar in tooth-implant FPD and mesial implant in the implant-implant FPD, revealed that the stress was significantly lower in tooth-implant FPD when compared with implant-implant FPD (21.1 ± 0.00 vs 46.1 ± 0.00, P < .001). Stress distribution in the bone around any implant depends on several factors such as diameter, length, and tooth-implant vs implant-implant support. The implant diameter was more significant for improved stress distribution than implant length. A moderate increase in the length of the implant consequently reduced stress.

Composite Resins chemistry, Inlays, Denture, Partial, Fixed, Finite Element Analysis, Dental Stress Analysis methods, Stress, Mechanical, and Dental Bonding

Statement of Problem: The cantilevered resin-bonded fixed dental prosthesis (RBFDP) is a feasible and minimally invasive treatment option to restore a single missing tooth, especially when the missing tooth space is small (<7 mm) and cost-effectiveness is essential. However, its long-term survival needs to be improved by increasing its structural strength and interfacial adhesion.
Purpose: The purpose of this study was to improve the interfacial bonding and to enhance the structural strength of a 2-unit inlay-retained cantilevered RBFDP with a 2-step numerical shape optimization.
Material and Methods: A finite element model of a mandibular first molar with a second premolar pontic was constructed. A load of 200 N simulating the average occlusal force was applied on the mesial fossa of the pontic. In the first step, an in-house user-defined material subroutine was used to generate the cavity preparation. The subroutine iteratively changed the tooth tissues next to the pontic to composite resin according to the local stresses until convergence was achieved. In the second step, the subroutine was used to optimize the placement of fibers in the pontic by placing fibers in high-stress regions. To assess the debonding resistance and load capacity of the optimized and conventional designs, further analyses were conducted to compare their stresses at the tooth-restoration interface and those within the restoration.
Results: Shape optimization resulted in a shovel-shaped cavity preparation and a pontic with fibers placed near the occlusal surface of the connector region. With the optimized cavity preparation only, the maximum principal stress within the restoration and the tooth structure was reduced from 639.4 MPa to 525.4 MPa and from 381.7 MPa to 352.8 MPa, respectively. With the embedded fibers, the shovel-shaped cavity preparation reduced the maximum interfacial tensile stress by approximately 70% (conventional: 189.6 MPa versus optimized: 57.0 MPa) and the peak maximum principal stress of the veneering composite resin by 45% (conventional: 638.8 MPa versus optimized: 356.5 MPa). The peak maximum principal stress was also reduced for the remaining tooth structure by approximately 30% (conventional: 372.2 MPa versus optimized: 253.1 MPa).
Conclusions: Shape optimization determined that a shovel-shaped retainer with fibers placed near the occlusal surface of the connector area can collectively reduce the interfacial and structural stresses of the 2-unit cantilevered fiber-reinforced RBFDP. This may offer a more conservative treatment option for replacing a single missing tooth.
(Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Humans, Dental Restoration Failure, Dental Prosthesis, Implant-Supported, Dental Stress Analysis methods, Bone Screws, and Dental Implants

Objectives: The aim of this study was to fractographically examine clinically fractured fixation screws used to fix implant supported restorations and to estimate stress at failure.
Methods: 20 clinically fractured titanium implant fixation screws were collected and analyzed under scanning electron microscope in order to locate critical crack origin and calculate stress at fracture. Principles of fractographic analysis were applied using relative equations and cause and conditions of screw fracture were calculated. X-rays and patients' records were collected after approval of necessary consent forms.
Results: Fractographic analysis revealed location and dimensions of critical crack size for every fractured screw examined. Two patterns of screw fracture were identified; the first was related to improper seating of fixation screw leading to damage at screw threads and eventual fracture of screw body. The second was related to slow crack growth propagation causing final fracture of screw body. The calculated stress at failure ranged from 755 to 804 MPa. Patients' records revealed that 75% of fractured screws were related to single unit screw retained restorations.
Significance: Single unit screw retained restorations and improperly seated implant abutments impose high stress concentration on fixation screw which may result in fixation screw fracture.
(Copyright © 2022 Elsevier Inc. All rights reserved.)

Humans, Dental Materials chemistry, Dental Stress Analysis methods, Finite Element Analysis, Glass Ionomer Cements chemistry, Composite Resins chemistry, and Dental Restoration, Permanent methods

Background: Partial restoration combined with periodontal root coverage surgery can be applied to the treatment of non-carious cervical lesions (NCCLs) accompanied with gingival recessions in clinical practice. However, the feasibility of NCCL partial restorative treatment from a biomechanical perspective remains unclear. This study aimed to investigate the effect of partial restorations on stress distributions in the NCCLs of mandibular first premolars via three-dimensional finite element analysis.
Methods: Three-dimensional finite element models of buccal wedge-shaped NCCLs in various locations of a defected zenith (0 mm, 1 mm, and 2 mm) were constructed and divided into three groups (A, B, and C). Three partially restored NCCL models with different locations of the lower restoration border (1 mm, 1.5 mm, and 2 mm), and one completely restored NCCL model were further constructed for each group. The following restorative materials were used in all restoration models: composite resin (CR), glass-ionomer cement (GIC), and mineral trioxide aggregate (MTA). The first principal stress distributions under buccal oblique loads of 100 N were analyzed. Restoration bond failures were also evaluated based on stress distributions at dentin-restoration interfaces.
Results: When the partial restoration fully covered the defected zenith, the first principal stress around the zenith decreased and the maximum tensile stress was concentrated at the lower restoration border. When the partial restoration did not cover the defected zenith, the first principal stress distribution patterns were similar to those in unrestored models, with the maximum tensile stress remaining concentrated at the zenith. As the elastic modulus of the restorative material was altered, the stress distributions at the interface were not obviously changed. Restoration bond failures were not observed in CR, but occurred in GIC and MTA in most models.
Conclusions: Partial restorations that fully covered defected zeniths improved the stress distributions in NCCLs, while the stress distributions were unchanged or worsened under other circumstances. CR was the optimal material for partial restorations compared to GIC and MTA.
(© 2022. The Author(s).)

Humans, Dental Stress Analysis methods, Ultrasonics, X-Ray Microtomography, Torque, Bone Screws, Dental Abutments, and Dental Implants

The aim of this work was to analyze and compare the removal capability, conical internal hex implant-abutment connection damage and thermal effect using ultrasonic and drilling techniques for the extraction of fractured abutment screws. Twenty abutment screws were randomly fractured into twenty dental implants and randomly extracted using the following removal techniques: Group A: drilling technique without irrigation (n = 10) (DT) and Group B: ultrasonic technique without irrigation (n = 10) (UT). The dental implants were submitted to a preoperative and postoperative micro-computed tomography (micro-CT) scan to obtain a Standard Tessellation Language (STL) digital file that determined the wear comparison by morphometry. Moreover, the thermographic effects generated by the DT and UT removal techniques were registered using a thermographic digital camera. Comparative analysis was performed by comparing the volumetric differences (mm 3 ) between preoperative and postoperative micro-CT scans and thermographic results (°C) using the Student t test. The DT extracted 8/10 and the US 9/10 abutment screws. The pairwise comparison revealed statistically significant differences between the volumetric differences of postoperative and preoperative micro-CT scans of the DT (- 0.09 ± - 0.02mm 3 ) and UT (- 0.93 ± - 0.32mm 3 ) study groups (p = 0.0042); in addition, the pairwise comparison revealed statistically significant differences between the thermographic values of the DT (38.12 ± - 10.82 °C) and UT (78.52 ± 5.43 °C) study groups (p < 0.001). The drilling technique without irrigation provides a less removal capability, less conical internal hex implant-abutment connection damage and less thermal effect than ultrasonic technique for the extraction of fractured abutment screws; however, the ultrasonic technique resulted more effective for the extraction of fractured abutment screws.
(© 2022. The Author(s).)

Dental Abutments, Dental Stress Analysis methods, X-Ray Microtomography, Titanium, Microscopy, Gold Alloys, Alloys, Gold, Dental Prosthesis Retention, and Dental Implants

Background: The prosthetic screw fixes the prostheses to the implants. Upon osteointegration, the untightening of the prosthetic screw is the most common problem in oral rehabilitation with implants.
Objective: To study the deformation of the implant retaining hexagonal screw head.
Methods: This investigation used two methods for evaluating the screw head's area of deformation (mm 2 ): a stereoscopic microscopy and micro computed tomography (microCT). For stereoscopic microscopy, 16 titanium alloy (T) and 16 titanium gold-plated alloy (G) screws of the Zimmer Biomet™ brand were used, divided into eight groups: group 0 (control group), groups T1 and G1 (screws tightened 10 times to 20 Ncm), the groups T2 and G2 (screws tightened 20 times to 20 Ncm) and the groups T3 and G3 (screws tightened 10 times to 30 Ncm). In the study with microCT, one screw was randomly chosen from each of the groups described above to perform the scanning by microCT.
Results: When comparing the type of screw material using stereoscopic microscopy, no statistically significant differences were found (p > 0.05). Contrarily, different number of successive grips and different torque value showed statistically significant differences in the head section of the retaining screws (p < 0.05). The observation by microCT showed the torque applied is crucial to the head deformation in titanium screws. In gold-plated screws the successive tightening appears to be pivotal.
Conclusion: Titanium and gold screws tend to behave similarly. By increasing the tightening cycles and the torque values of protocols greater levels of deformations can be expected. In general, microCT data showed better results for gold-plated titanium alloy.
Clinical Significance: To control severe screw head deformation and the impossibility of untightening the implant's restoration, clinicians should avoid extreme torque values and prevent surpassing 10 tightening cycles.
(© 2022 Wiley Periodicals LLC.)

Humans, Dental Stress Analysis methods, Dental Prosthesis Design, Stress, Mechanical, Mandible diagnostic imaging, Dental Prosthesis, Implant-Supported, and Dental Implants

Background: Many clinical studies have reported the high success rate of the All-on-4 concept. In the present study, we aimed to compare the stress distribution with different tilted distal implants and cantilever lengths in an All-on-4 system using the two-dimensional photoelastic method and to establish the All-on-4 implant photoelastic model by computer-aided design (CAD) and rapid prototyping (RP).  METHODS: The data of the human edentulous mandible were acquired by computed tomography (CT). Three human edentulous mandible All-on-4 implant models with different distally inclined implant holes were fabricated using Mimic, Geomagic Studio software, and a light solidifying fast shaping machine. Then the final photoelastic models were established through the traditional method. Each of the three models had four NobelSpeedy Replace implants between the interforaminal regions. The two posterior implants were placed 0, 15, and 45 degrees distally before the mental foramen. The four implants were splinted by wrought cobalt-chromium alloy frameworks. Each of the three photoelastic models was submitted to a 150 N vertical load at five points on the framework: the central fossa of the mandibular first molar, and 0 mm, 5 mm, 10 mm, and 15 mm of the cantilever length. The stress produced in the models was photographed with a digital camera, and the highest value of the stressed fringe pattern was recorded.
Results: The All-on-4 implant photoelastic model established by CAD and RP was highly controllable and easy to modify. The position and inclination of implants were accurate, and the frameworks could be passively emplaced. The stress values were higher around a single tilted implant compared with the distal implant in All-on-4 with the same inclination. The 0-degree distal implant and 45-degree distal implant demonstrated the highest and lowest stress when loading at the central fossa of the mandibular first molar, respectively. With the same inclination of distal implant, the peri-implant bone stress increased as the length of cantilever increased.
Conclusion: The method of establishing the All-on-4 implant photoelastic model by CAD and RP was highly controllable, convenient, fast, and accurate. The tilted implants splinted in the fully fixed prosthesis with reduced cantilever lengths did not increase the stress level compared with the vertical distal implants.And this illustrated that the influence of cantilever on stress distribution was greater than the influence of implant inlination.
(© 2022. The Author(s).)

Nickel, Orthodontic Appliance Design, Titanium, Torque, Stainless Steel, Dental Stress Analysis methods, Stress, Mechanical, Materials Testing, Orthodontic Wires, and Orthodontic Brackets

Purpose: The aim was to compare rectangular multiforce nickel-titanium (NiTi) wires to rectangular wires with only one force zone. Both types of wires are primarily intended for use during the levelling phase of orthodontic treatment. Thus, basic mechanical properties were examined by means of a three-point bending test. Torque expression, which is dependent on both wire parameters and interslot distances, was analyzed using the Orthodontic Measurement and Simulation System (OMSS).
Material/methods: Four multizone products were tested: DuoForce™ (Forestadent, Pforzheim, Germany), TriTanium™ (American Orthodontics, Sheboygan, WI, USA), Triple Force™ (ODS, Kisdorf, Germany), Bio-Active™ (GC, Breckerfeld, Germany), and two multistrand products without force zones: a nine-strand NiTi, TurboWire™ (Ormco, Orange, CA, USA) and an eight-strand stainless steel (SS) wire, Multibraid™ (GAC, Dentsply Sirona, York, PA, USA). All the wires had the dimension 0.40 mm × 0.56 mm (0.016 inch × 0.022 inch) except the nine-strand NiTi wire TurboWire™, which had a dimension of 0.43 mm × 0.65 mm (0.017 inch × 0.025 inch). Six different bracket systems in the 0.018 inch slot system were chosen: the conventional brackets discovery® and discovery® smart (Dentaurum, Ispringen, Germany), the active self-ligating brackets InOvation™ and InOvation™ mini (GAC, Dentsply Sirona, York, PA, USA) and the passive self-ligating brackets Carrière™ (ODS, Kisdorf, Germany) and BioPassive® (Forestadent, Pforzheim, Germany). The first set-up was a three-point bending test according to DIN EN ISO 15841. For the second experiment, the bracket products glued on a maxilla model were combined with the wire products. The torque moments arising during torqueing of the wires between +20° and -20° were measured in three positions: first incisor, canine and second bicuspid.
Results: Bending tests confirmed variation of the force corresponding to the force zones. The nine-strand NiTi wire TurboWire TM and the eight-strand SS wire Multibraid™ did not show any variation dependent on the tested area. Torque-moments generated by the multizone wires were higher compared to the braided wires. The nine-strand NiTi wire showed the lowest moments in spite of the higher dimension. As expected, increasing the interbracket distance reduced the torque moments.
Conclusion: The tests verified the existence of multiple force zones in the NiTi wires for forces and moments, respectively. As the torque-moments arising from the multizone wires were rather high, it is not recommended to use these wires as a first "leveling wire" in orthodontic treatment, especially in extremely crowded cases.
(© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Humans, Finite Element Analysis, Stress, Mechanical, Biomechanical Phenomena, Maxilla diagnostic imaging, Maxilla surgery, Dental Stress Analysis methods, Imaging, Three-Dimensional methods, Computer Simulation, Dental Implant-Abutment Design, and Dental Implants

Platform-switching reduces peri-implant marginal bone loss (MBL). The aim of this study was to compare the effect of platform-switching on stress within crestal bone using different implant-abutment mismatches (0.65 and 1 mm) under 2 different vertical loads (30 N vs 200 N) for implants placed in posterior jaw sites. Three-dimensional modeling software was used for an implant with a diameter of 4.5 mm and length of 13 mm. Molars were modeled using computerized tomography images of bone density in human maxilla (D3 bone) and mandible (D2 bone). Collected data were analyzed using CATIA software. In posterior mandible, stress of 30 N force with platform mismatches of 0.65 or 1 mm were 2.920 and 2.440 MPa respectively. Using 200 N force, values increased to 19.44 and 16.30 MPa. In posterior maxilla and 30 N force, stresses with mismatches of 0.65 and 1 mm were 3.77 and 3.18 MPa, respectively, increasing to 25.14 and 20.17 MPa with 200 N force. The effect can be predicted to be greatest as the mismatch increases with implants placed into lower quality bone (posterior maxilla with D3 quality).

Dental Stress Analysis methods, Orthodontic Appliance Design, Tooth Movement Techniques, Incisor, and Orthodontic Appliances, Removable

Objectives: To evaluate the force delivered by removable thermoplastic appliances (RTAs, aligners), altered with Hilliard precision thermopliers, on an upper central incisor to tip it in the palatal and vestibular directions.
Materials and Methods: A total of 10 aligners made from Ideal Clear® (polyethylene terephthalate glycol copolyester, PET-G) with a thickness of 1 mm were used in force analysis. Different-sized spot-thermoformed protuberances (bumps) were generated by activating the thermoplier (thin and thick) up to 30°, 60° and 90° in the centre of the palatal and vestibular surfaces of the aligner in 15° steps. The tipping (Fx) and intrusive (Fz) force components were measured on the isolated upper central incisor as part of a standardized resin model, with or without vertical loading by a weight equivalent.
Results: Thermoplier activation at 30°, 60° and 90° resulted in different bump heights. The analysis revealed significantly higher Fx and Fz values with increasing bump heights for every activation step in all cases (p < 0.0001, respectively). Overall, the values of the Fx force component were higher than those observed for Fz. Significant differences between the palatal and vestibular tipping procedures were found depending on the resulting force components when the thin thermoplier was used; in contrast, the thick thermoplier resulted in a larger dispersion of the force magnitudes.
Conclusions: Aligners modified with Hilliard precision thermopliers showed altered biomechanical parameters. This approach could be an option for treatment modification.
Clinical Relevance: The instrumental examination provided informative results for daily practice, as activation, force dosage and different force values under chewing pressure can be estimated more precisely based on the determined force levels.
(© 2022. The Author(s).)

Humans, Finite Element Analysis, Bone Density, Dental Stress Analysis methods, Stress, Mechanical, Biomechanical Phenomena, Bone and Bones, Dental Abutments, Dental Implant-Abutment Design, and Dental Implants

Statement of Problem: Various kinds of implants of different diameters and connection types are used for patients with a range of bone densities and tooth sizes. However, comprehensive studies simultaneously analyzing the biomechanical effects of different diameters, connection types, and bone densities are scarce.
Purpose: The purpose of this 3-dimensional finite element analysis study was to evaluate the stress and strain distribution on implants, abutments, and surrounding bones depending on different diameters, connection types, and bone densities.
Material and Methods: Twelve 3-dimensional models of the implant, restoration, and surrounding bone were simulated in the mandibular first molar region, including 2 bone densities (low, high), 2 implant-abutment connection types (internal tissue level, internal bone level), and 3 implant diameters (3.5 mm, 4.0 mm, and 4.5 mm). The occlusal force was 200 N axially and 100 N obliquely. Statistical analysis was performed using the general linear model univariate procedure with partial eta squared (η p 2 ) (α=.05).
Results: For bone tissue, low-density bone induced a larger maximum and minimum principal strain (in magnitude) than high-density bone (P<.001). As the implant diameter increased, the volume of the cancellous bone in low-density bone at the atrophy region (strain<200 με) increased (P<.001). For implant and abutment, the internal bone-level connection type was associated with increased peak stress as compared with the tissue-level connection type (P<.001). For all models, the stress distribution on the implant complex was influenced by implant diameter (P<.001): a decrease in implant diameter increased the stress concentration.
Conclusions: The implant connection type had a greater impact on the stress of the implant and abutment than the diameter. A tissue-level connection was more advantageous than a bone-level connection in terms of stress distribution of the implant and abutment. Bone density was the most influential factor on bone strain. The selection of dental implants should be made considering these factors and other important factors including tooth size.
(Copyright © 2020 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Finite Element Analysis, Dental Stress Analysis methods, Titanium, Stress, Mechanical, Esthetics, Dental, Dental Abutments, Maxilla, and Dental Implants

Purpose: The optimal abutment material and design for an angled implant-abutment connection in the esthetic zone is unclear. The purpose of this finite element analysis (FEA) study was to compare different abutment models by evaluating the stress values in the implant components and strain values on the simulated bone around an anterior maxillary implant with different angled abutment models and loading conditions.
Materials and Methods: One Ø3.5×12-mm implant was placed in 3D FEA models representing the anterior left lateral segment of the maxilla. Three different contemporary implant models were created with 17° or 25° angled abutments (Ti base abutment, zirconia abutment, and titanium abutment) and 3D-modeled. The implant abutment model was an angled Ti base abutment (TIB), an angled zirconia abutment (ZIR), or an angled titanium abutment (TIT). Vertical and oblique loads of 100 N for the central incisors were applied as boundary conditions to the cingulum area and incisal area in a nonlinear FEA.
Results: The TIB model resulted in reduced stress conditions. According to the von Mises stresses occurring on the screw, abutment, crown, and implant, especially under oblique loads, the TIB model was exposed to less stress than the ZIR or TIT models. Strain values in simulated cortical and trabecular bones were obtained lower in the TIB model.
Conclusions: When a standard implant was placed in the esthetic zone at an increased angle, the implants, abutments, and screws had more unfavorable stress levels; therefore, using a Ti-base abutment may reduce stress. The amount of contact surface of the implant with the simulated cortical bone is also an important factor affecting stress and strain.
(© 2021 by the American College of Prosthodontists.)

Alloys, Biomechanical Phenomena, Dental Stress Analysis methods, Finite Element Analysis, Humans, Stress, Mechanical, Titanium, and Dental Implants

Background: The combination of a prosthetic index with Morse taper connection was developed, with the purpose of making prosthetic procedures more precise. However, the presence of the index may compromise the mechanical performance of the abutment. The aim of this study is to evaluate the effect of prosthetic index on stress distribution in implant-abutment-screw system and peri-implant bone by using the 3D finite element methodology.
Methods: Two commercial dental implant systems with different implant-abutment connections were used: the Morse taper connection with platform switching (MT-PS) implant system and the internal hex connection with platform matching (IH-PM) implant system. Meanwhile, there are two different designs of Morse taper connection abutment, namely, abutments with or without index. Consequently, three different models were developed and evaluated: (1) MT-PS indexed, (2) MT-PS non-indexed, and (3) IH-PM. These models were inserted into a bone block. Vertical and oblique forces of 100 N were applied to each abutment to simulate occlusal loadings.
Results: For the MT-PS implant system, the maximum stress was always concentrated in the abutment neck under both vertical and oblique loading. Moreover, the maximum von Mises stress in the neck of the MT-PS abutment with index even exceed the yield strength of titanium alloy under the oblique loading. For the IH-PM implant system, however, the maximum stress was always located at the implant. Additionally, the MT-PS implant system has a significantly higher stress level in the abutment neck and a lower stress level around the peri-implant bone compared to the IH-PM implant system. The combined average maximum stress from vertical and oblique loads is 2.04 times higher in the MT-PS indexed model, and 1.82 times for the MT-PS non-indexed model than that of the IH-PM model.
Conclusions: MT-PS with index will cause higher stress concentration on the abutment neck than that of without index, which is more prone to mechanical complications. Nevertheless, MT-PS decreases stress within cancellous bone and may contribute to limiting crestal bone resorption.
(© 2022. The Author(s).)

Bone Screws, Crowns, Dental Cements, Dental Implant-Abutment Design, Dental Materials, Dental Stress Analysis methods, Epoxy Resins, Materials Testing, Titanium, Torque, Zirconium, Dental Abutments, and Dental Implants

Statement of Problem: The angled screw channel concept has become popular. However, research is lacking as to how reverse torque values of nonaxially tightened implant crowns compare with axially tightened cement-retained crowns restored on angle-correcting abutments when subjected to long-term cyclic loading.
Purpose: The purpose of this in vitro study was to evaluate the ability of different 25-degree angled screw channel hexalobular systems to apply the target torque value on their screws, the effect of cyclic loading on their reverse torque values, and their survival compared with crowns cemented on conventional 0-degree screw channel abutments.
Material and Methods: A total of 28 implants were divided into 4 groups. Twenty-one angled screw channel crowns were fabricated at a 25-degree angle correction by using angled titanium (Ti) bases by 3 manufacturers DY (Dynamic Tibase), DE (AngleBase), and ASC (Angulated Screw Channel) (n=7). The fourth group, UB (Universal Base, Control), had cement-retained crowns with 25-degree custom-milled, angled zirconia abutments that were cemented onto their respective Ti bases (n=7). All implants were embedded in epoxy resin blocks and tightened to manufacturer recommended values: 35 Ncm for ASC, UB, and DE and 25 Ncm for DY. Initial torque values (ITV1) were recorded. After 24 hours, the reverse torque values (24hr-RTV1) were recorded. A new set of screws was then used for each group, and the initial torque values (ITV2) were recorded. Specimens were loaded at 2 Hz for 5 million cycles under a 200-N load, and reverse torque values (RTV2) were recorded. ANOVA (α=.05) was used to compare differences in the means of deviation of initial torque values and means of reverse torque values followed by a Tukey-Kramer post hoc analysis (α=.05). Preload efficiency was calculated for each system (RTV2/ITV2), and a survival analysis was performed by using the Lifetest procedure.
Results: A significant difference in the means of deviation of initial torque values of the groups with 25-degree torque application (DY, DE, and ASC) was found when compared with UB at 0 degrees. ASC and DE had lower initial torque values than UB (P<.001 and P=.003 for ASC ITV1 and ITV2, P<.001 and P=.006 for DE ITV1 and ITV2). A significant difference was found in mean reverse torque values both for after 24 hours and after cyclic loading among all groups (P<.001). A significant difference was found between mean reverse torque values before and after cyclic loading for each group (P<.001). Preload efficiency was 43.8% for DY, 46.8% for DE, 54.2% for ASC, and 48.5% for UB. No significant difference was found in the time-to-failure survival among groups (P>.05).
Conclusions: The hexalobular system of DY delivered comparable initial torque values to its target value at 25 degrees, similar to how UB (control group) delivered at 0 degrees. ASC and DE scored lower initial torque values than their target value compared with UB. The DY abutment, which had a lower manufacturer recommended torque value, had lower reverse torque values compared with those of other groups. Time-to-failure survival of all groups was similar. Fractures at the zirconia to titanium base connection were seen with ASC crowns.
(Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Bicuspid, Composite Resins, Dental Stress Analysis methods, Finite Element Analysis, Humans, Materials Testing, Ceramics, and Crowns

Introduction: To analyze the stress distribution of the all-ceramic endocrown with different base materials and thicknesses using three-dimensional finite element analysis.
Methods: A endodontically treated maxillary premolar was scanned by micro-CT, a three-dimensional finite element model of the endocrown with fluid resin as the base material was divided into control (0 mm), 1 mm, 2 mm, and 3 mm groups according to base thickness. Three kinds of conventional base materials were used and divided into glass ion group (A), fluid resin group (B), and nanocomposite resin group (C), and a three-dimensional finite element model of the endocrown with 1.0 mm thickness of base was established. A static loading with axial and 45° direction was applied to each model, the stress distribution of each part of the endocrown was analyzed under different base materials and thicknesses.
Results: The different thickness of the base layer has an influence on the components of the restoration and the tooth. The stress in the control group was the largest. The stress was the lowest when the thickness of the base layer was 1 mm; The maximum of the equivalent stress, the first, second, and third principal stress in the endocrown, abutment, and alveolar bone, are basically the same with the different base materials. The stress on the base layer increases with the elastic modulus of base materials increases.
Conclusions: The base layer played a force buffering effect on the dental body restored with endocrowns, and the effect was the best at 1 mm; The selection of base material has little influence on the whole, but in order to protect the weak tissues of the cavity bottom, the base material with lower elastic modulus can be used.
(© 2022. The Author(s).)