Biomechanical Modelling for Tooth Survival Studies: Mechanical Properties, Loads and Boundary Conditions-A Narrative Review

Bioimplant-on-a-Chip for Facile Investigation of Periodontal Ligament Formation on Biogenic Hydroxyapatite/Ti6Al4 V Implants

Highly osseointegrative dental implants surrounded by reconstructed periodontal tissues represent a promising strategy for functional tooth replacement, as they mimic the structural and physiological characteristics of natural teeth. However, there is currently a lack of in vitro platforms that can effectively evaluate the integration of engineered periodontal ligament (PDL) tissues with bioimplants. In this study, we developed a bioimplant-on-a-chip (BoC) platform designed to recapitulate the native PDL-cementum interface and assess the early stage biological performance of bioimplants in vitro. The BoC consists of a dental implant, a calcium phosphate cement (CPC) insert, a nanopatterned polydimethylsiloxane (PDMS) substrate, and PDL-like tissue derived from human dental pulp stem cells (DPSCs). To establish viable culture conditions within the platform, surface coatings and cell seeding densities were optimized to support the formation of PDL-like tissue. Nanogrooved substrates were incorporated to guide cellular alignment, which was assessed through orientation analysis. Collagen fiber organization and matrix deposition were further examined as indicators of ligamentous tissue maturation. Cementogenic activity was evaluated by immunofluorescent staining of cementum protein-1 (CEMP-1) in response to varying biogenic hydroxyapatite (bHA) contents in the bioimplants. The results demonstrated successful reproduction of a PDL-like tissue interface and material-dependent differences in CEMP-1 expression. This platform provides a modular and reproducible tool for the comparative evaluation of bioimplants in a physiologically relevant setting and may be useful in advancing regenerative strategies in dental implantology.

Finite Element Analysis of Implant Stability Quotient (ISQ) and Bone Stresses for Implant Inclinations of 0°, 15°, and 20°

This study aimed to utilize finite element analysis (FEA) to evaluate the primary stability of Cyroth dental implants (AoN Implants Srl, Grisignano di Zocco, Italy) under various biomechanical conditions, including different implant inclinations (0°, 15°, and 20°) and bone densities (D3 and D4). By comparing these results with those obtained from in vitro tests on polyurethane blocks, the study sought to determine whether FEA could provide stability information more quickly and efficiently than in vitro methods. The research involved correlating dental implant micro-mobility with the implant stability quotient (ISQ) using FEA to simulate the mechanical behavior of implants and the surrounding bone tissue. Additionally, the study assessed the error in ISQ value detection by comparing FEA results with in vitro tests on polyurethane blocks conducted under the same experimental conditions. Both the FEA simulations and in vitro experiments demonstrated similar trends in ISQ values. For the D3 bone block simulated by FEA, the difference from the in vitro test was only 1.27%, while for the D2 bone, the difference was 2.86%. The findings also indicated that ISQ increases with implant inclination and that bone quality significantly affects primary stability, with ISQ decreasing as bone density diminishes. Overall, this study showed that ISQ evaluation for dental implants can be effectively performed through FEA, particularly by examining micro-movements. The results indicated that FEA and in vitro polyurethane testing yielded comparable outcomes, with FEA providing a faster and more cost-effective means of assessing ISQ across various clinical scenarios compared to in vitro testing.

Exploring the mechanical and biological interplay in the periodontal ligament

The periodontal ligament (PDL) plays a crucial role in transmitting and dispersing occlusal force, acting as mechanoreceptor for muscle activity during chewing, as well as mediating orthodontic tooth movement. It transforms mechanical stimuli into biological signals, influencing alveolar bone remodeling. Recent research has delved deeper into the biological and mechanical aspects of PDL, emphasizing the importance of understanding its structure and mechanical properties comprehensively. This review focuses on the latest findings concerning both macro- and micro- structural aspects of the PDL, highlighting its mechanical characteristics and factors that influence them. Moreover, it explores the mechanotransduction mechanisms of PDL cells under mechanical forces. Structure-mechanics-mechanotransduction interplay in PDL has been integrated ultimately. By providing an up-to-date overview of our understanding on PDL at various scales, this study lays the foundation for further exploration into PDL-related biomechanics and mechanobiology.

Structural response of mandibular first molars in the presence of proximal contacts: finite element analysis with antagonist teeth and alternative loading applications

OBJECTIVES

To compare the mechanical responses of a mandibular molar under functional loads using antagonist teeth and different loading applications and configurations.

METHODS

A cone-beam computed tomography of a human mandible and maxilla was used to build 16 different three-dimensional models, including four mandibular configurations [single-tooth model (first mandibular molar-M), and inclusion of mesial (mM), distal (Md) or both proximal contacts (mMd)] and occlusal load applications either with antagonist teeth or alternative Finite Element (FE) models [point load (PL), distributed surface load (SL) and rigid metal sphere (MS)]. FE analysis was performed. Equivalent von Mises (VM) stress was calculated along the entire dentin and periodontal ligament of the first mandibular molar. Maximum VM stresses were compared among the different mandibular configurations and loading applications.

RESULTS

The highest and lowest VM stress at 50 and 100 N corresponded respectively to the single-tooth SL model (5.78 and 11.5 MPa) and to occlusal load application with antagonist teeth and proximal contacts (2.08 and 3.58 MPa). Maximum VM stresses were consistently located at the cervical area of the mesial root and decreased when adjacent teeth were present.

CONCLUSIONS

Highest stresses are located in the cervical area of the mesial root of mandibular molars, but the biomechanical behavior depends on the presence of proximal contacts and the loading methodologies used. Single-tooth models represent the worst structural scenario.

CLINICAL RELEVANCE

Incorporating antagonist teeth and proximal contacts into FE models enhances the biofidelity of dental biomechanics simulations, enabling more accurate extrapolation to clinical conditions.

The influence of thermal tempering on the fracture resistance, surface microstructure, elemental surface composition, and phase analysis of four heat-pressed lithia-based glass ceramic crowns

BACKGROUND

This in-vitro study aimed to evaluate the impact of thermal tempering and ceramic type on the fracture resistance, surface microstructure, elemental surface composition and phase analysis of four heat-pressed glass ceramics.

METHODS

A total of 84 glass-ceramic crowns were pressed and randomly allocated into four equal groups (n = 21) according to the ceramic type: Group (E): IPS e.max Press, Group (L): GC initial LiSi Press, Group (C): Celtra Press and Group (A): VITA Ambria. The crowns of each group were equally allocated into three subgroups (n = 7) regarding the subsequent thermal tempering temperature. Subgroup (T0): No tempering. Subgroup (T1): Tempering at 9% below pressing temperature. Subgroup (T2): Tempering at 5% below pressing temperature. Samples were tested for fracture resistance using a universal testing machine. A scanning electron microscope, X-ray diffraction, and Energy Dispersive x-ray analysis were utilized to disclose the microstructural features.

RESULTS

When there is no tempering, IPS e.max press showed a significant elevated fracture resistance (P-value = 0.002). There was an insignificant difference between other ceramics. While with tempering (T2) as well as (T1), Lisi press (L) showed a significant elevated fracture resistance. There was an insignificant difference between other ceramics (P-value = 0.004).

CONCLUSIONS

Incorporation of zirconia oxide into the lithium disilicate glass matrix did not show improvement in the fracture resistance. Thermal tempering procedure had significant effect on fracture resistance. Thermal tempering technique had no influence the elemental surface composition and phase analysis yet T2 samples showed changes in crystal size and orientation.

The Effect of Different Separated File Retrieval Strategies on the Biomechanical Behavior of a Mandibular Molar: A Finite Element Analysis Study

INTRODUCTION

This study evaluated the effects of retrieval strategies of separated nickel-titanium files on the biomechanical behavior of endodontically treated teeth by finite element analysis.

METHODS

Six FE models were created: intact tooth; simulated a scenario where the apical 3 mm of a nickel-titanium file is separated and retained; TD, simulated application of a trephine drill to expose 1 mm of the separated file; simulated troughing of 180° at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform; simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD; and PM, simulated iatrogenic perforation sealed using mineral trioxide aggregate. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses, maximum principal stresses, safety factor, and number of cycles till failure were determined. The cervical region of the teeth and mid-root sections including the separated file was chosen as the areas of interest for further analysis.

RESULTS

Intact tooth recorded the highest number of cycles till failure and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest number of cycles till failure. The highest von Mises stress was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the intact tooth.

CONCLUSION

Under the limitation of this study, various file retrieval strategies removing the surrounding root dentin within the amounts of general guidelines do not affect the biomechanical behavior of the tooth.

Compression Behavior of Dental Flowable Composites-Digital Image Correlation and Numerical Analysis

In the development of restorative materials, it is important to evaluate the elastic properties of the material in order to achieve good clinical results. The aim of this study was to evaluate the compression behavior of two dental flowable materials (EverX Flow and Flow-Art) using experimental methods and numerical simulation. The Poisson's ratio was determined using two methods of strain measurement: the electrical strain gauge method (ESG) and digital image correlation (DIC). Material constants determined in experimental studies were implemented in a numerical model, and displacement analysis was conducted using the finite element method (FEM). The tests showed higher compressive strength and modulus of elasticity for EverX Flow compared to Flow-Art. The values of the Poisson's ratio were similar for both measurement methods, ranging from 0.27 to 0.28 for EverX Flow and from 0.30 to 0.32 for Flow-Art. This demonstrated the feasibility of the DIC method for obtaining the Poisson's ratio values for this type of composites. Compression test conditions were reproduced in the numerical analysis. The obtained distributions of the displacement field on the surface of the sample from the DIC and numerical analyses were compared. A good match was observed between DIC displacement measurements and displacement values obtained in FEM analysis. The comprehensive approach used in the study allows us to analyze whether the results obtained in the numerical simulation correspond to the material response to the applied load and validate the model.

Experimental and Finite Element Analysis of Compressive Strength and Diametral Tensile Strength of Luting Cement: An In Vitro Study

Background Strength parameters greatly influence the selection of luting agents. This study compared the compressive and diametral tensile strengths (DTS) of three luting cements. Materials and methods Three luting cements, conventional glass ionomer (CGI), resin-modified glass ionomer (RMGI), and resin cement (RC), were tested for compressive strength and DTS. Forty-two standardized specimens were prepared, measuring 4 mm by 6 mm for compressive tests and 6 mm by 3 mm for diametral tensile tests. The luting materials were prepared according to the manufacturers' instructions. Result Experimental mean compressive and diametral strengths and standard errors were calculated for each luting agent (n = 10). Analysis of variance was computed (p < 0.05), and multiple comparison tests were performed. RC showed significantly higher compressive strengths and DTS among the three tested luting cements, while the CGI showed the least. The results obtained by finite element analysis (FEA) for both tests closely matched the experimental results. Conclusion In this study, it was concluded that the mean compressive strength and DTS values of all three luting cements were significantly different. The resin luting cement exhibited the highest compressive strength and DTS, while the CGI exhibited the least.

Advancements in Periodontal Regeneration: A Comprehensive Review of Stem Cell Therapy

Periodontal disease, characterized by inflammation and infection of the supporting structures of teeth, presents a significant challenge in dentistry and public health. Current treatment modalities, while effective to some extent, have limitations in achieving comprehensive periodontal tissue regeneration. This comprehensive review explores the potential of stem cell therapy in advancing the field of periodontal regeneration. Stem cells, including mesenchymal stem cells (MSCs) and induced pluripotent stem cells (iPSCs), hold promise due to their immunomodulatory effects, differentiation potential into periodontal tissues, and paracrine actions. Preclinical studies using various animal models have revealed encouraging outcomes, though standardization and long-term assessment remain challenges. Clinical trials and case studies demonstrate the safety and efficacy of stem cell therapy in real-world applications, especially in personalized regenerative medicine. Patient selection criteria, ethical considerations, and standardized treatment protocols are vital for successful clinical implementation. Stem cell therapy is poised to revolutionize periodontal regeneration, offering more effective, patient-tailored treatments while addressing the systemic health implications of periodontal disease. This transformative approach holds the potential to significantly impact clinical practice and improve the overall well-being of individuals affected by this prevalent oral health concern. Responsible regulatory compliance and a focus on ethical considerations will be essential as stem cell therapy evolves in periodontal regeneration.

Silver coating on dental implant-abutment connection screws as potential strategy to prevent loosening and minimizing bacteria adhesion

Introduction: One of the main problems for the long-term behavior of dental implants are loosening of the implant-abutment connection screws and bacterial infiltration. The aim of this work is to increase the screw fixation by silver coating, providing superior mechanical retaining and antibacterial effect. Methods: Eighty dental implants with their abutments and screws have been studied. Twenty screws were not coated and were used as a control while the rest of screws were silver coated by sputtering, with three different thickness: 10, 20 and 40 μm and 20 screws per each thickness. Coating morphology and thickness were determined by scanning electron microscopy using image analysis systems. The screws were tightened for each of the thicknesses and the control with two torques 15 Ncm and 20 Ncm and tested under mechanical fatigue simulating oral stresses up to a maximum of 500,000 cycles. The remaining torques at different cycles were determined with a high-sensitivity torquemeter. Cell viability assays were performed with SaOs-2 osteoblasts and microbiological studies were performed against Streptococcus gordonii and Enterococcus faecalis bacteria strains, determining their metabolic activity and viability using live/dead staining. Results: It was observed a decrease in torque as cycles increase. For a preload of 15 Ncm at 100,000 cycles, the loosening was complete and, for 20 Ncm at 500,000 cycles, 85% of torque was lost. The silver coatings retained the torque, especially the one with a thickness of 40 μm, retaining 90% of the initial torque at 500,000 cycles. It was observed that osteoblastic viability values did not reach 70%, which could indicate a slight cytotoxic effect in contact with cells or tissues; however, the screw should not be in direct contact with tissue or living cells. Silver coating induced a significant reduction of the bacteria metabolic activity for Streptococcus gordonii and Enterococcus faecalis, around 90% and 85% respectively. Discussion: Therefore, this coating may be of interest to prevent loosening of implant systems with a worthy antibacterial response.

How loss of tooth structure impacts the biomechanical behavior of a single-rooted maxillary premolar: FEA

To evaluate the influence of the loss of coronal and radicular tooth structure on the biomechanical behavior and fatigue life of an endodontically treated maxillary premolar with confluent root canals using finite element analysis (FEA). An extracted maxillary second premolar was scanned to produce intact (IT) 3D model. Models were designed with an occlusal conservative access cavity (CAC) with different coronal defects; mesial defect (MO CAC), occlusal, mesial and distal defect (MOD CAC), and 2 different root canal preparations (30/.04, and 40/.04) producing 6 experimental models. FEA was used to study each model. A simulation of cycling loading of 50N was applied occlusally to stimulate the normal masticatory force. Number of cycles till failure (NCF) was used to compare strength of different models and stress distribution patterns via von Mises (vM) and maximum principal stress (MPS). The IT model survived 1.5 × 1010 cycles before failure, the CAC-30.04 had the longest survival of 1.59 × 109, while the MOD CAC-40.04 had the shortest survival of 8.35 × 107 cycles till failure. vM stress analysis showed that stress magnitudes were impacted by the progressive loss of coronal tooth structure rather than the radicular structure. MPS analysis showed that significant loss of coronal tooth structure translates into more tensile stresses. Given the limited size of maxillary premolars, marginal ridges have a critical role in the biomechanical behavior of the tooth. Access cavity preparation has a much bigger impact than radicular preparation on their strength and life span.

The effect of periapical bone defects on stress distribution in teeth with periapical periodontitis: a finite element analysis

BACKGROUND

Apical periodontitis directly affects the stress state of the affected tooth owing to the destruction of the periapical bone. Understanding the mechanical of periapical bone defects/tooth is clinically meaningful. In this study, we evaluate the effect of periapical bone defects on the stress distribution in teeth with periapical periodontitis using finite element analysis.

METHODS

Finite element models of normal mandibular second premolars and those with periapical bone defects (spherical defects with diameters of 5, 10, 15, and 20 mm) were created using a digital model design software. The edges of the mandible were fixed and the masticatory cycle was simplified as oblique loading (a 400 N force loaded obliquely at 45° to the long axis of the tooth body) to simulate the tooth stress state in occlusion and analyze the von Mises stress distribution and tooth displacement distribution in each model.

RESULTS

Overall analysis of the models: Compared to that in the normal model, the maximum von Mises stresses in all the different periapical bone defect size models were slightly lower. In contrast, the maximum tooth displacement in the periapical bone defect model increased as the size of the periapical bone defect increased (2.11-120.1% of increase). Internal analysis of tooth: As the size of the periapical bone defect increased, the maximum von Mises stress in the coronal cervix of the tooth gradually increased (2.23-37.22% of increase). while the von Mises stress in the root apical region of the tooth showed a decreasing trend (41.48-99.70% of decrease). The maximum tooth displacement in all parts of the tooth showed an increasing trend as the size of the periapical bone defect increased.

CONCLUSIONS

The presence of periapical bone defects was found to significantly affect the biomechanical response of the tooth, the effects of which became more pronounced as the size of the bone defect increased.

Options for Access Cavity Designs of Mandibular Incisors: Mechanical Aspects from Finite Element Study

INTRODUCTION

This study investigated different access cavity designs of mandibular anteriors in terms of their effect on the biomechanical behavior and longevity using finite element analysis (FEA).

METHODS

A 3-dimensional model of a mandibular incisor was created for FEA. After validating the intact tooth (IT) model, 4 experimental models were developed (traditional lingual access cavity [TLA], facial access cavity [FAC], incisal access cavity [ICA], and cervical access cavity [CVA]). Cyclic loading was simulated, and the number of cycles until failure (NCF) was compared to the IT model. Stress distribution patterns, maximum von Mises stresses (vMSs), and maximum principal stresses (MPSs) were analyzed mathematically. The safety factor was also calculated and demonstrated.

RESULTS

The maximum vMS registered on the IT model was 134.16 MPa. The FCA and the CVA provided the highest NCF (193.7% compared with the IT model) followed by ICA (58.2%) and TLA (21.4%). The vM and MPS analysis revealed that the lingual surface is a primary stress channel, and the presence of an access cavity significantly weakens the tooth structure. Although the maximum vMS registered for the IT model was 134.16 MPa, the maximum vMS was 73.97 MPa for both the FCA and the CVA, 152.27 MPa for the ICA, and 173.63 MPa for the TLA.

CONCLUSIONS

The facial and cervical access cavity designs provided considerable reinforcement to the endodontically treated mandibular incisors. With advancements in esthetic restorative materials and endodontic instruments, facial access design could emerge as the new standard for access cavity preparation in mandibular incisors.

Functional Load Capacity of Teeth with Reduced Periodontal Support: A Finite Element Analysis

The purpose of this study was to investigate the functional load capacity of the periodontal ligament (PDL) in a full arch maxilla and mandible model using a numerical simulation. The goal was to determine the functional load pattern in multi- and single-rooted teeth with full and reduced periodontal support. CBCT data were used to create 3D models of a maxilla and mandible. The DICOM dataset was used to create a CAD model. For a precise description of the surfaces of each structure (enamel, dentin, cementum, pulp, PDL, gingiva, bone), each tooth was segmented separately, and the biomechanical characteristics were considered. Finite Element Analysis (FEA) software computed the biomechanical behavior of the stepwise increased force of 700 N in the cranial and 350 N in the ventral direction of the muscle approach of the masseter muscle. The periodontal attachment (cementum-PDL-bone contact) was subsequently reduced in 1 mm increments, and the simulation was repeated. Quantitative (pressure, tension, and deformation) and qualitative (color-coded images) data were recorded and descriptively analyzed. The teeth with the highest load capacities were the upper and lower molars (0.4-0.6 MPa), followed by the premolars (0.4-0.5 MPa) and canines (0.3-0.4 MPa) when vertically loaded. Qualitative data showed that the areas with the highest stress in the PDL were single-rooted teeth in the cervical and apical area and molars in the cervical and apical area in addition to the furcation roof. In both single- and multi-rooted teeth, the gradual reduction in bone levels caused an increase in the load on the remaining PDL. Cervical and apical areas, as well as the furcation roof, are the zones with the highest functional stress. The greater the bone loss, the higher the mechanical load on the residual periodontal supporting structures.

Effect of Proximal Caries-driven Access on the Biomechanical Behavior of Endodontically Treated Maxillary Premolars

INTRODUCTION

This study investigated the effects from the carious cavity and access from it on the fracture resistance of endodontically treated maxillary premolars using finite element analysis (FEA).

METHODS

A maxillary premolar was used to compare 3 types of access cavity related to having a proximal carious defect: caries-driven access (CDA), conservative access that has a mesial component (MCA), as well as traditional access with the same mesial component (MTA). Cyclic loading was simulated on the occlusal surface, and number of cycles until failure (NCF) was compared with the intact tooth model (IT). Mathematical analysis was done to evaluate the stress distribution patterns and calculated maximum von Mises (vM) and maximum principal stresses (MPS), with emphasis on pericervical region as a specific area of interest.

RESULTS

Maximum vM registered on the IT was 6.14 MPa. CDA provided the highest NCF with 92.28% of the IT, followed by MCA (84.90%) and MTA (83.79%). The vM and MPS analysis showed that the stress values and patterns are affected more by the proximity of the occlusal load to the tooth/restoration interface. Concerning the pericervical region, maximum vM was registered for IT (4.11 MPa), followed by CDA (4.85 MPa) and then MCA (8.13 MPa) and MTA (8.61 MPa), whereas the MPS analysis revealed that CDA showed the highest magnitude of tensile stresses.

CONCLUSIONS

A proximal CDA benefits the mechanical properties of maxillary premolars; however, its impact on the biological aspect should be assessed to provide a ruling for/against it.

Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects

The clinical challenge of bone defects in the craniomaxillofacial region, which can lead to significant physiological dysfunction and psychological distress, persists due to the complex and unique anatomy of craniomaxillofacial bones. These critical-sized defects require the use of bone grafts or substitutes for effective reconstruction. However, current biomaterials and methods have specific limitations in meeting the clinical demands for structural reinforcement, mechanical support, exceptional biological performance, and aesthetically pleasing reconstruction of the facial structure. These drawbacks have led to a growing need for novel materials and technologies. The growing development of 3D printing can offer significant advantages to address these issues, as demonstrated by the fabrication of patient-specific bioactive constructs with controlled structural design for complex bone defects in medical applications using this technology. Poly (ether ether ketone) (PEEK), among a number of materials used, is gaining recognition as a feasible substitute for a customized structure that closely resembles natural bone. It has proven to be an excellent, conformable, and 3D-printable material with the potential to replace traditional autografts and titanium implants. However, its biological inertness poses certain limitations. Therefore, this review summarizes the distinctive features of craniomaxillofacial bones and current methods for bone reconstruction, and then focuses on the increasingly applied 3D printed PEEK constructs in this field and an update on the advanced modifications for improved mechanical properties, biological performance, and antibacterial capacity. Exploring the potential of 3D printed PEEK is expected to lead to more cost-effective, biocompatible, and personalized treatment of craniomaxillofacial bone defects in clinical applications.

Corrosion and Mechanical Behavior of Metal Materials

Many high-strength metal-related materials and structures work under the coupling condition of harsh corrosion environments and complex loading [...].