Behaviours of three-dimensional compressive and tensile forces exerted on a tooth during function

Impact of implant location on load distribution of implant-assisted removable partial dentures: a review of in vitro model and finite-element analysis studies

BACKGROUND

Appropriate load distribution among the supporting elements is essential for the long-term success of implant-assisted removable partial dentures; however, there is little information available on load distribution.

PURPOSE

This study aimed to evaluate the effect of implant location on load distribution in implant-assisted removable partial dentures by reviewing in vitro models and finite-element analysis studies.

MATERIALS AND METHODS

English-language studies which examined the load distribution of implant-assisted removable partial dentures and were published between January 2001 and October 2022 were extracted from PubMed, ScienceDirect, and Scopus online databases, and manual searching. Two reviewers selected the articles based on the predetermined inclusion and exclusion criteria, followed by data extraction and analysis.

RESULTS

Forty-seven studies were selected after evaluating the titles and abstracts of 264 articles; two were identified manually. After screening the text, 12 studies were included: six in vitro model experiments and six finite-element analysis studies. All included studies used a mandibular free-end missing model (Kennedy Class I or II). The influence of implant location on load distribution to the abutment tooth, implant, and mucosa under the denture base was summarized in three cases: implant at the premolar, first molar, and second molar region. Due to differences in the measurement method of load distribution and loading condition to the denture, the results differed among the studies.

CONCLUSIONS

The implant location in implant-assisted removable partial dentures can affect load distribution to the supporting elements, such as the abutment tooth, implant, and mucosa under the denture base.

In vivo measurement of three-dimensional load exerted on dental implants: a literature review

Background

For biomechanical consideration of dental implants, an understanding of the three-dimensional (3D) load exerted on the implant is essential, but little information is available on the in vivo load, including the measuring devices.

Purpose

This review aimed to evaluate studies that used specific load-measuring devices that could be mounted on an implant to measure the functional load in vivo.

Materials and methods

An electronic search utilizing the internet research databases PubMed, Google Scholar, and Scopus was performed. The articles were chosen by two authors based on the inclusion and exclusion criteria.

Results

In all, 132 studies were selected from the database search, and 16 were selected from a manual search. Twenty-three studies were finally included in this review after a complete full-text evaluation. Eleven studies were related to the force measurements using the strain gauges, and 12 were related to the piezoelectric force transducer. The principles of the two types of devices were completely different, but the devices produced comparable outcomes. The dynamics of the load magnitude and direction on the implant during function were clarified, although the number of participants in each study was small.

Conclusions

The load exerted on the implant during function was precisely measured in vivo using specific measuring devices, such as strain gauges or piezoelectric force transducers. The in vivo load data enable us to determine the actual biomechanical status in more detail, which might be useful for optimization of the implant prosthetic design and development of related materials. Due to the limited data and difficulty of in vivo measurements, the development of a new, simpler force measurement device and method might be necessary.

Comparison of retention and fracture load of endocrowns made from zirconia and zirconium lithium silicate after aging: an in vitro study

BACKGROUND

This study aimed to compare retention and fracture load in endocrowns made from translucent zirconia and zirconium lithium silicate.

METHODS

Fifty-six intact human maxillary molars after being mounted in acrylic resin, were scanned to acquire biogeneric copies. Specimens underwent standard endodontic treatment and were prepared for endocrown up to 2 mm above the cementoenamel junction. The specimens were randomly divided into two groups of 28, and endocrowns were designed using biogeneric copies and milled from high-translucent zirconia disks (Zr) and zirconium lithium silicate blocks (ZLS). After cementation with dual-cure resin cement, all the specimens underwent thermomechanical aging, and pull-out retention test and compressive test were conducted (14 specimens were used for each test in each group, n = 14), and failure modes in both tests were evaluated.

RESULTS

Independent samples t-test showed significant difference between the retention of Zr (271.5 N ± 114.31) and ZLS (654.67 N ± 223.17) groups (p value = 0.012). Compressive test results were also significantly different between Zr (7395.07 N ± 1947.42) and ZLS (1618.3 N ± 585) (p = 0.002). Failure mode of retention test was primarily adhesive failure at the cement-restoration interface in Zr group and cement-tooth interface in ZLS group. Failure modes of fracture test for Zr group were 7 non-restorable fractures and one restorable fracture while 6 specimens resisted compressive loads up to 8500 N without fracture. ZLS group showed 7 restorable and 7 non-restorable failures.

CONCLUSIONS

Zr endocrowns showed significantly lower retention and higher fracture strength. Both materials seem to be suitable for fabrication of endocrown in clinical setup.

Reference value of masticatory performance by measuring the amount of glucose extraction from chewing gummy jelly

PURPOSE

The purpose of this study was to determine a reference value for masticatory performance (MP) by measuring the amount of glucose extracted(AGE) from chewing gummy jelly.

METHODS

A total of 237 young adults (young group, 20-39 years), 147 middle-aged adults (middle-aged group, 40-59 years), and 177 older adults (old group, 60-87 years) participated in this study. All participants had natural dentition, excluding the third molars. AGE was measured when the participant chewed gummy jelly and used as a parameter of MP. AGE was compared among the three groups. Next, AGE in each group was compared between the habitual chewing side and non-habitual chewing side, and between males and females. The correlation between age and AGE was also investigated.

RESULTS

AGE in the young, middle, and old groups were similar, and no significant differences were observed. AGE was significantly higher in the habitual chewing side compared to the non-habitual chewing side, and in males than that in females. No significant correlations were found between age and AGE. AGE in the habitual chewing side of all ages was 221.9 ± 34.4 mg/dL for males and 206.0 ± 28.7 mg/dL for females. The mean-2SD (standard deviation) value representing the reference value of healthy adults was 153.1 mg/dL for males and 148.6 mg/dL for females, which was close to 150 mg/dL.

CONCLUSION

It was concluded that the reference value of masticatory performance as measured by the amount of glucose extraction after chewing gummy jelly was 150 mg/dL.

Fracture resistance and crystal phase transformation of a one- and a two-piece zirconia implant with and without simultaneous loading and aging-An in vitro study

OBJECTIVE

To evaluate the influence of artificial aging on the transformation propagation and fracture resistance of zirconia implants.

METHODS

One-piece (with integrated implant abutment, 1P; regular diameter [4.1mm]; n = 16) and two-piece (with separate implant abutment, 2P; wide diameter [5 mm]; n = 16) zirconia implants were embedded according to ISO 14801. A two-piece titanium-zirconium implant (Ti-Zr; 4.1 mm diameter) served as a control (n = 16). One subgroup (n = 8) of each system was simultaneously dynamically loaded (10⁷ cycles; 98N) and hydrothermally aged (85°C, 58 days), while the other subgroup (n = 8) remained untreated. Finally, specimens were statically loaded to fracture. Potential crystal phase transformation was examined at cross sections using scanning electron microscopy (SEM). A multivariate linear regression model was applied for statistical analyses.

RESULTS

The fracture resistance of 1P (1,117 [SD = 38] N; loaded/aged: 1,009 [60] N), 2P (850 [36] N; loaded/aged: 799 [84] N), and Ti-Zr implants (1,338 [205] N; loaded/aged: 1,319 [247] N) was not affected significantly by loading/aging (p = .171). However, when comparing the systems, they revealed significant differences independent of loading/aging (p ≤ .001). Regarding the crystal structure, a transformation zone was observed in SEM images of 1P only after aging, while 2P showed a transformation zone even before aging. After hydrothermal treatment, an increase of this monoclinic layer was observed in both systems.

CONCLUSIONS

The Ti-Zr control implant showed higher fracture resistance compared to both zirconia implants. Loading/aging had no significant impact on the fracture resistance of both zirconia implants. The wide-body 2P zirconia implant was weaker than the regular body 1P implant.

A Novel Zirconia-Based Composite Presents an Aging Resistant Material for Narrow-Diameter Ceramic Implants

A novel ceria-stabilized zirconia-alumina-aluminate composite (Ce-TZP-comp) that is not prone to aging presents a potential alternative to yttrium-stabilized zirconia for ceramic oral implants. The objective of this study was to evaluate the long-term stability of a one-piece narrow-diameter implant made of Ce-TZP-comp. Implant prototypes with a narrow (3.4 mm) and regular (4.0 mm) diameter were embedded according to ISO 14801, and subgroups (n = 8) were subsequently exposed to dynamic loading (10⁷ cycles, 98N) and/or hydrothermal treatment (aging, 85 °C). Loading/aging was only applied as a combined protocol for the 4.0 mm diameter implants. One subgroup of each diameter remained untreated. One sample was cross-sectioned from each subgroup and evaluated with a scanning electron microscope for phase-transformation of the lattice. Finally, the remaining samples were loaded to fracture. A multivariate linear regression model was applied for statistical analyses (significance at p < 0.05). All samples withstood the different loading/aging protocols and no transformation propagation was observed. The narrow diameter implants showed the lowest fracture load after combined loading/aging (628 ± 56 N; p < 0.01), whereas all other subgroups exhibited no significantly reduced fracture resistance (between 762 ± 62 and 806 ± 73 N; p > 0.05). Therefore, fracture load values of Ce-TZP-comp implants suggest a reliable intraoral clinical application in the anterior jaw regions.

Evaluation of occlusal force and masticatory performance in elderly adults with natural dentition unaffected by occlusal support

PURPOSE

This study aimed to clarify whether occlusal force and masticatory performance reduced in elderly adults and whether these parameters were affected by age.

METHODS

Seventy-eight elderly adults (elderly group) and 76 young adults (control group) with natural dentition were asked to maximally clench for 3 s, and occlusal force was calculated. The amount of glucose extraction after chewing a gummy jelly was measured as the parameter for masticatory performance. Occlusal force and masticatory performance were compared between the elderly and control groups. The correlation between age and occlusal force and between age and masticatory performance was also investigated.

RESULTS

Occlusal force was significantly smaller in the elderly group (P < 0.05). Masticatory performance was lower in the elderly group, but this difference was not statistically significant. No significant correlation was observed between age and occlusal force in the control group, but a negative correlation was found in the elderly group (P < 0.05). No significant correlation was found between age and masticatory performance in either group.

CONCLUSION

Occlusal force was affected by age and reduced significantly, whereas masticatory performance was not affected by age and was maintained in elderly adults.

The effects of bone remodeling on biomechanical behavior in a patient with an implant-supported overdenture

This study aimed to clarify the effects of bone remodeling on biomechanical behavior in a patient with a mandibular implant-supported overdenture by comparing computed tomography-based finite element analyses (CT-FEA) with two time points of CT data. The present FEA was based on CT data collected from a 62-year-old female subject, who wore a mandibular implant overdenture supported by four dental implants with bar attachment. Two kinds of FE models were constructed from CT data taken at two time points: pre-implantation (Original-model) and 12 years post-implantation (Aged-model). FE models consisted of patient-specific model geometry and heterogeneous material properties. The deviation analysis was carried out to assess the changes in bone mass over a period of 12 years. The results show an averaging of intraosseous stress and strain energy density between the implant regions in the Aged-model. The results of the morphological assessments demonstrated that the bone mass and quality had significantly changed over 12 years. Area-specific bone resorption was also observed at the bone surrounding each implant. The combined findings indicate that the averaging of mechanical variables was due to chronological changes in bone morphology, suggesting adaptation to mechanical loads by peri-implant bone remodeling.

Effect of peri-implant bone resorption on mechanical stress in the implant body: In vivo measured load-based finite element analysis

BACKGROUND

Research on resolving implant fracture is still gaining attention as it can be a serious treatment failure outcome. The implant fracture is likely to occur due to increased stress in implant body associated with peri-implant bone resorption.

OBJECTIVE

This study aimed to investigate the relationship between degree of peri-implant bone resorption and stress distribution in implant body by using finite element analysis (FEA).

METHODS

The magnitude and direction of loads on implants at the mandibular molar region were measured with 3D piezoelectric force transducers in a patient during maximal voluntary clenching, grinding and tapping to obtain input for the FEA as the loading condition. Simplified finite element bone models were generated to simulate the six patterns of peri-implant bone resorption progression which the bone levels from implant platform were set at 0, 1, 2, 3, 4 and 5 mm. Three types of implants with different diameters (3.5, 4.0 and 5.0 mm), corresponding abutments and screws were created. FEA using the in vivo measured load was conducted to investigate how peri-implant bone loss affects stress distribution in the implant body.

RESULTS

Loading condition affected stress distribution in the implant body. As bone resorption increased, von Mises stress in the implant body became larger, which was marked in smaller diameter implants, and this change was amply demonstrated when the bone resorption increased from 0 to 2 mm.

CONCLUSION

The FEA demonstrated that as peri-implant bone loss increased, the magnitude of stress in the implant increased, especially in small diameter implants.

Mechanically-induced GDF15 Secretion by Periodontal Ligament Fibroblasts Regulates Osteogenic Transcription

The alveolar bone provides structural support against compressive and tensile forces generated during mastication as well as during orthodontic treatment. To avoid abnormal alveolar bone resorption and tooth loss, a balanced bone turnover by bone-degrading osteoclasts and bone-generating osteoblasts is of great relevance. Unlike its contradictory role in regulating osteoclast and osteoblast cell differentiation, the TGF-β/BMP-family member GDF15 is well known for its important functions in the regulation of cell metabolism, as well as cell fate and survival in response to cellular stress. Here, we provide first evidence for a potential role of GDF15 in translating mechanical stimuli into cellular changes in immature osteoblasts. We detected enhanced levels of GDF15 in vivo in periodontal ligament cells after the simulation of tooth movement in rat model system as well as in vitro in mechanically stressed human periodontal ligament fibroblasts. Moreover, mechanical stimulation enhanced GDF15 secretion by periodontal ligament cells and the stimulation of human primary osteoblast with GDF15 in vitro resulted in an increased transcription of osteogenic marker genes like RUNX2, osteocalcin (OCN) and alkaline phosphatase (ALP). Together, the present data emphasize for the first time a potential function of GDF15 in regulating differentiation programs of immature osteoblasts according to mechanical stimulation.

Satisfaction in complete denture wearers with and without adhesives: A randomized, crossover, double-blind clinical trial

Background

The purpose of this study was to compare the satisfaction of patients regarding retention, stability and accumulation of particles with a randomized, double-blind crossed method in users with complete dentures with and without adhesive.

Material and Methods

Seventeen edentulous individuals were randomized and received new upper and lower complete dentures. After a period of adaptation, they participated in some masticatory tests and clinical revisions, after use the protheses with and without the use of two denture adhesives: Adhesive A (Fittydent, Fittydent International GmbH) and adhesive B (Corega, GlaxoSmithKline) at 0, 7 and 14 days. Satisfaction was measured immediately after each test through a survey using a VAS scale (0-10) and data were analyzed with McNemar's test with Bonferroni correction.

Results

The results showed significant differences (p<.01) between the study groups with adhesive A - B and the group without adhesive, but no significant differences were found between the two stickers for any of the variables studied.

Conclusions

Complete denture adhesives significantly improved the satisfaction of patients because a better retention, stability and less accumulation of particles of the food substitute between the denture and the mucosa is obtained compared with non-use of complete denture adhesives. Key words:Complete dentures, patient satisfaction, denture adhesives, clinical trials.

Identification of dynamic load for prosthetic structures

Dynamic load exists in numerous biomechanical systems, and its identification signifies a critical issue for characterizing dynamic behaviors and studying biomechanical consequence of the systems. This study aims to identify dynamic load in the dental prosthetic structures, namely, 3-unit implant-supported fixed partial denture (I-FPD) and teeth-supported fixed partial denture. The 3-dimensional finite element models were constructed through specific patient's computerized tomography images. A forward algorithm and regularization technique were developed for identifying dynamic load. To verify the effectiveness of the identification method proposed, the I-FPD and teeth-supported fixed partial denture structures were investigated to determine the dynamic loads. For validating the results of inverse identification, an experimental force-measuring system was developed by using a 3-dimensional piezoelectric transducer to measure the dynamic load in the I-FPD structure in vivo. The computationally identified loads were presented with different noise levels to determine their influence on the identification accuracy. The errors between the measured load and identified counterpart were calculated for evaluating the practical applicability of the proposed procedure in biomechanical engineering. This study is expected to serve as a demonstrative role in identifying dynamic loading in biomedical systems, where a direct in vivo measurement may be rather demanding in some areas of interest clinically.

Effect of attachment type on load distribution to implant abutments and the residual ridge in mandibular implant-supported overdentures

This study aimed to investigate the effect of attachment type on the load transmitted to implants and the residual ridge in a mandibular two-implant-supported overdenture in a model study. Ball attachments, locator attachments, and round-bar attachments were selected and examined. Static and dynamic vertical loads of 100 N were applied in the right first molar region. The load on the implants was measured by piezoelectric three-dimensional force transducers, and the load on the residual ridge beneath the denture base was measured using a tactile sheet sensor. The load on the implants with ball attachments was significantly higher than that with the other two attachments. The load on the residual ridge with round-bar attachments was significantly higher than that with the other two attachments. Our findings indicate that the three-dimensional load on implants and the residual ridge beneath the denture base is significantly associated with the type of attachment used in implant-supported overdentures.

A dynamic model of jaw and hyoid biomechanics during chewing

Our understanding of human jaw biomechanics has been enhanced by computational modelling, but comparatively few studies have addressed the dynamics of chewing. Consequently, ambiguities remain regarding predicted jaw-gapes and forces on the mandibular condyles. Here, we used a new platform to simulate unilateral chewing. The model, based on a previous study, included curvilinear articular guidance, a mobile hyoid apparatus, and a compressible food bolus. Muscles were represented by Hill-type actuators with drive profiles tuned to produce target jaw and hyoid movements. The cycle duration was 732 ms. At maximum gape, the lower incisor-point was 20.1mm down, 5.8mm posterior, and 2.3mm lateral to its initial, tooth-contact position. Its maximum laterodeviation to the working-side during closing was 6.1mm, at which time the bolus was struck. The hyoid's movement, completed by the end of jaw-opening, was 3.4mm upward and 1.6mm forward. The mandibular condyles moved asymmetrically. Their compressive loads were low during opening, slightly higher on the working-side at bolus-collapse, and highest bilaterally when the teeth contacted. The model's movements and the directions of its condylar forces were consistent with experimental observations, resolving seeming discordances in previous simulations. Its inclusion of hyoid dynamics is a step towards modelling mastication.