Journal of Biomechanics 47 (2014) 3830–3836

Contents lists available at ScienceDirect

Journal of Biomechanics
journal homepage: www.elsevier.com/locate/jbiomech
www.JBiomech.com

Finite element analysis of dental implant loading on atrophic

and non-atrophic cancellous and cortical mandibular
bone – a feasibility study
Petr Marcián a,n, Libor Borák a, Jiří Valášek a, Jozef Kaiser b, Zdeněk Florian a, Jan Wolff c,d
a
Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2,
616 69 Brno, Czech Republic
b
X-ray Micro CT and Nano CT Research Group, CEITEC – BUT, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
c
Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, FI-33521, Tampere, Finland
d
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands

art ic l e i nf o a b s t r a c t

Article history: The first aim of this study was to assess displacements and micro-strain induced on different grades of
Accepted 18 October 2014 atrophic cortical and trabecular mandibular bone by axially loaded dental implants using finite element
analysis (FEA). The second aim was to assess the micro-strain induced by different implant geometries and
Keywords: the levels of bone-to-implant contact (BIC) on the surrounding bone. Six mandibular bone segments
Dental implant demonstrating different grades of mandibular bone atrophy and various bone volume fractions (from 0.149
Micro-CT to 0.471) were imaged using a micro-CT device. The acquired bone STL models and implant (Brånemark,
Mandible Straumann, Ankylos) were merged into a three-dimensional finite elements structure. The mean displace-
Finite element analysis ment value for all implants was 3.171.2 mm. Displacements were lower in the group with a strong BIC. The
Bone-implant-contact
results indicated that the maximum strain values of cortical and cancellous bone increased with lower bone
density. Strain distribution is the first and foremost dependent on the shape of bone and architecture of
cancellous bone. The geometry of the implant, thread patterns, grade of bone atrophy and BIC all affect the
displacement and micro-strain on the mandible bone. Preoperative finite element analysis could offer
improved predictability in the long-term outlook of dental implant restorations.
& 2014 Elsevier Ltd. All rights reserved.

1. Introduction entire circumference of the implant that results in the imm-

In recent years, the number of dental implants placed worldwide
has increased dramatically. Consequently, the occurrence of implant
failures has also increased. This increase in implant failure warrants a
better understanding of implant stress and strain distribution on the
adjacent bone. Load transfer depends on the type of loading, the bone-
implant interface, the length and diameter of the implants, the shape
and characteristics of the implant surface and the type of prosthesis, as
well as the quality of the surrounding bone (Geng et al., 2001).
The purpose of this study was to develop a method to assess
the loading induced at the implant-to-bone interface using
linearly-elastic finite element analysis (FEA) on a mCT-based model
that includes both the trabecular and cortical architecture of the
bony structure.
After dental implant placement and uneventful healing, imp-
lants should demonstrate an intimate bone apposition around the
n
Corresponding author. Tel.: þ 420 54114 2871; fax: þ 420 541 142 876.
E-mail address: marcian@fme.vutbr.cz (P. Marcián).
obility of the implant. The resulting immobility, however, offers
less force-absorbing capabilities when compared to natural teeth
that are better adapted to excessive loading. Therefore, the main-
tenance of the implant-to-bone interface is of paramount impor-
tance in the determination of clinical success. Mechanical factors
in dental implant failure cannot be overlooked given the increased
incidence of component fractures (Morgan et al., 1993), coronal
bone resorption (Quirynen et al., 1992), and fixture loss (Van
Steenberghe et al., 2002) in situations of compromised prosthetic
reconstruction and long-term loading.
In order to better understand the reasons for mechanical com-
plications in implant dentistry, it is necessary to develop a more
sophisticated method for detailed analysis that allows the assess-
ment of the stress and strain fields in implant components as well as
local stress distribution at the bone-implant interface. Current
procedures for assessing forces in the implant-to-bone interface
have limitations. Stress assessments in vivo are technically unfea-
sible, and therefore in vitro methods of assessment have to be
considered. One common method of stress assessment is, for
example, the use of photoelastic materials for photoelasticimetry

http://dx.doi.org/10.1016/j.jbiomech.2014.10.019
0021-9290/& 2014 Elsevier Ltd. All rights reserved.
 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836
measurements (Asvanund and Morgano, 2011). This method offers
visual stress patterns but mostly in a qualitative way, that is, in the
case of complex structures such as trabecular architecture, no
specific strain values can be obtained using this method. In addition,
the method is unfeasible for the analysis of bone with detailed
trabecular architecture because of experimental setup limitations.
A valuable analytical tool that offers the solution to the
problems outlined above is computational modelling using num-
erical methods. In recent years, FEA has been introduced as the
successful representative of computational modelling methods.
Using FEA in implant dentistry is a logical step that is based on the
long-term successful experience in other fields of human biome-
chanics (Achour et al., 2011 and Wirth et al., 2012). The mechanical
behaviour of a structure can be written as a function of the
displacements of the nodes. Thanks to the latest hardware
capabilities, even very complex geometries such as the bone-to-
implant contact (BIC) can be discretized and a set of algebraic
equations solved to investigate the strain and stress distributions.
Currently, this method is commonly used for the analysis of
implant-bone interactions but, interestingly, rarely for the analysis
of the trabecular architecture (Achour et al., 2011; Al-Sukhun et al.,
2007; Huang et al., 2010; Lan et al., 2012; Özdemir Doğan et al.,
2014; Saidin et al., 2012 and Van Oosterwyck et al., 2002). The
stress patterns and especially the specific values obtained from
such methods are far from reality because the trabecular archi-
tecture is an extremely significant factor (Limbert et al., 2010;
Wirth et al., 2010, 2012 and) in the assessment of the BIC and
hence of the osseointegration. Advanced computational equip-
ment and imaging devices (mCT) now offer new possibilities to
create models that allow the assessment of bone with different
grades of mineralization combined with different implant types
and thus geometries. The grade of mineralization in trabecular and
cortical bony structures and implant geometries can vary mark-
edly. Consequently, they have a major influence on the BIC and the
degree of osseointegration.
Fig. 1. Mechanostat threshold.
Fig. 2. a) Six morphologically different bone samples acquired from a female and a male mandible, b) comparison of BVF for all specimens’.
3831
Julius Wolff first described the phenomenon of adaptive
changes to physiologic bone loading followed by secondary
changes to the external cortical portion of the bone in 1892
Wolff (1892). In the 1960s, Frost introduced the Mechanostat
Hypothesis that is a refinement of Wolff's law (Frost, 2001, 2004
and Martin and Burr, 1989). The hypothesis allows a better
understanding of the clinical and experimental observations of
the changes occurring in bone under different loading conditions
and hence elastic deformation. It has to be noted, however, that
the strain range may differ in the same individual depending on
the site of the assessment (Lanyon, 1992 and Rubin and Lanyon,
1985). Nevertheless, the Mechanostat hypothesis offers a useful
clinical reference for the hierarchy of biomechanical responses to
applied loads (Roberts, 2008). The elastic deformation of bone is
commonly measured in microstrain (mε), that is, 1000 mε are equal
to a 0.1% change in bone length. Physiological loading values of
about 1000 to 1500 mε are commonly attained during normal
mastication (Fig. 1) (Frost, 2004). However, loads exceeding the
minimal effective strain (about 1500 mε) can often result in a
hypertrophic increase in modelling and a concomitant decrease in
remodelling (Frost, 2004). When peak strains exceed values of
about 3000 mε, however, the structural integrity of the bone is
endangered and can in some cases result in pathological overload
(Frost, 2004).
2. Materials and methods
Six morphologically different mandibular bone segments (Fig. 2) were obtained
from patients that had bequeathed their bodies to the Anatomical Institute of
Masaryk University in Brno and to the VU University, Amsterdam for medical-
scientific research and training purposes. The Ethics Committees of both Institutes
agreed to the removal of the mandibles after the study protocol had been ethically
reviewed and approved. The bone segments were removed from three females
(aged 39, 47 and 59 years) and three males (aged 58, 67 and 75 years). The mCT
images of each bone segment are shown in Fig. 2a (henceforth, each segment is
labelled with the letter F or M for the sex and with a number for the age, e.g. F(39)
means “female aged 39 years”, etc.).
The mCT images of the bone segments were acquired using a non-series-
produced mCT device TOMOLAB (Synchrotron Elettra, Trieste, Italy) and a GE
v|tome|xL240 mCT device (General Electric, USA). Two segments (F(39) and M(67))
were measured using the TOMOLAB device (pixel size of 17 mm); the other
segments were measured using the GE device (pixel size of 25 mm). The acquired
mCT data sets were subsequently used to calculate the bone volume fraction (BVF)
of cancellous bone in all bone segments. Fig. 2b shows the average BVF values
calculated for all bone segments in their alveolar regions. All bone segments
demonstrated different grades of bone atrophy and consequently different thick-
nesses of the cortical structure. The average BVF ranged from 0.149 to 0.471.
2.1. Geometrical model
After BVF assessment, both mCT images were subsequently processed using STL
Model Creator software (Matlab 2010, MathWorks, USA) to obtain 3D standard
3832 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836

tessellation language (STL) files that were subsequently used for the construction of 2.5. Evaluation of the FEA results
FE models of the previously imaged mandible segments. In the next stage, three
geometrically different implant systems (Brånemarks System Mk III Groovy (NP Ø
The implant-to-bone interface analysis used in this study was based on
3.3 mm, 11.5 mm), Straumanns Standard Plus Implantat (SP Ø 3.3 RN SLA 12), and
Mechanostat threshold values. These values are commonly adopted for strain
ANKYLOS C/X Membrane Screw Implant A11 (Ø 3.5 mm, 11 mm) were scanned
analyses of the mandible (Bujtár et al., 2010; Field et al., 2012; Lin et al., 2010; Liu
(ATOS II Triple Scan, GOM mbH, Germany). The acquired data sets were then used
et al., 2013; Ormianer et al., 2012 and Sarrafpour et al., 2012).
to generate 3D models of the implants using SolidWorks 2012 (Dassault Systèmes,
France). Finally, the generated implant models were merged with the previously
acquired bone STL models using ANSYS 14 (ANSYS Inc., USA).
After merging the data sets, two different implant-to-bone interfaces were 3. Results
generated and assessed. The first implant-to-bone interface comprised only small
bony fragments that interconnected the implant to the bony wall (marked low BIC)
(Fig. 3). The second implant-to-bone interface comprised a (non-fragmented)
3.1. Displacements assessments
0.1 mm-thick bony layer around the complete circumference of the implant
(marked high BIC) mimicking different implant-to-bone interfaces and hence BIC. The 3D analysis of the three implant types placed into six bone
segments with different bone density revealed variations in the
2.2. Meshing procedure strain distribution and displacements in the bone tissues.
The mean displacement value for all implants applied in all
ANSYS 14 software was then used to generate a mesh of the individual evaluated bone segments was 3.171.2 mm. The mean axial displace-
components and to define materials, boundary conditions, and loads. All assess- ments of the Brånemark, Straumann and Ankylos implants applied
ments were discretized by 10-node quadratic element SOLID187 with a global size
in all bone segments are summarized in Fig. 4a–c, respectively. The
ranging from 0.05 mm to 0.5 mm. The implant-to-bone interface was modelled
using the elements CONTA175 and TARGE170. The total number of elements in all average implant displacements are summarized in Fig. 4d.
four cases oscillates around 7.5 million with approximately 10 million nodes.

3.2. Strain intensity assessments

2.3. Material model
The material properties of the bone tissue and dental implant were modelled
using the homogeneous isotropic linearly elastic material model that is explicitly
described by two material characteristics: Young's modulus (E) and Poisson's ratio
(μ). The implant material characteristics used in this study were E¼110 000 MPa and
m ¼0.3 (Kayabaşi et al., 2006; Mellal et al., 2004; Natali et al., 2008 and Van
Oosterwyck et al., 2002). The cancellous and cortical bone material characteristics
(E¼ 13 700 MPa) were modelled based on the findings of Bozkaya et al., 2004; Gei et
al., 2002; Kohles et al., 1997; Menicucci et al., 2002; Rho et al. (1997); Rubo and
Capello Souza (2010) and Turner et al., 1999; m¼ 0.3 modelled based on the findings of
Gei et al., 2002 and Menicucci et al., 2002.
The strain intensity distributions in the bone segments around
the Brånemark, Ankylos and Straumann implants are presented in
Figs. 5 and 6. All strains were assessed within the corono-apical
slices that offer the best visualization of the strain distribution in
the complicated geometrical micro-architecture of the bone tissue.
Moreover, for better understanding, the colour scale for the strain
distribution visualization was set to correspond with the intervals
of strain intensity thresholds (in micro-strain mε) suggested by
Frost (Fig. 1).

2.4. Boundary conditions

After merging the implant and bone data sets, all dental implants were loaded
with 200N in an axial direction on the uppermost cross section of the implant
based on the findings published (Petrie and Williams, 2005 and Soncini et al.,
2003). ANSYS provides several types of contact algorithms for the simulation of
different contact interfaces. Since, in our specific cases, no mutual movement of the
interacting components was needed, the “bonded always” option was used in the
multipoint constraint (MPC) algorithm (Wirth et al., 2012).
4. Discussion
A crucial factor for long-term implant success is implant
stability. Most importantly, implant stability is achieved at the
time of surgery and depends on the density of the bone at the site
of implantation, on the used surgical technique and on the implant
design (Sennerby and Meredith, 2008). In healthy osseointegrated

Fig. 3. Finite element models of two different bone-to-implant contacts, with and without a 0.1 mm-thick (low BIC and high BIC) interconnecting bony layer using three
geometrically different implants (example of bone sample 0.149F(39)).
 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836
Fig. 4. Implant displacement values in mm depending on BVF a) Brånemark dental implant, b) Straumann dental implant, c) Ankylos dental implant and d) average
displacements.
implants, the strains in the bone surrounding the implant are
normal or increased within physiological limits. In unfavourable
conditions, however, high stress concentrations as well as unphy-
siological low stresses in the bone can occur and often lead to
complications or even implant loss.
FEA has become an important tool in the assessment of such
biomechanical problems. It offers the possibility of measuring
displacements and strains induced on trabecular and cancellous
bony structures by dental implants (Natali et al., 2006). The
analysis method developed in this study replicates the trabecular
architecture of cancellous bone in the lower jaw and, thereby,
offers a unique possibility of investigating strain distributions
around dental implants in different bone morphologies and grades
of BIC.
4.1. Axial displacement
The axial displacement of dental implants is generally accepted as
one of the basic indicators of implant stability as discussed above. The
relationship between the axial displacements of dental implants and
bone density might appear obvious. However, the reality is a bit more
complicated than an intuitive view. Such a view would suggest that
the more dense cancellous bone is, the smaller the axial displacements
and, therefore, the higher the implant stability. This suggestion is in
agreement with the axial displacement results shown in Fig. 4 except
for F(39) that has the smallest value of BVF but does not provide the
largest axial displacements. Similarly, F(59) has smaller axial implant
displacements than M(58) although the former has slightly higher
BVF. The reason for this apparent mismatch with the intuitive view is
seen in Fig. 5. F(39) has significantly lower BVF than M(67) but, on the
contrary, it has much thicker cortical bone in the alveolar region. The
cortical bone in F(39) plays a much more important role in supporting
3833
the implant (and in its apparent stabilization) than in M(67). The
trabeculae are more evenly distributed around the implant and the
supporting role of the cortical bone in the alveolar region is negligible.
The axial displacements of the implants are, therefore, much more
dependent on the overall morphology of the bone than on the simple
qualification of BVF. Implant stability assessment based solely on the
axial displacement may, therefore, be tricky because the apparent high
implant stability determined from the low axial displacements may be
caused only by the cortical bone in the alveolar region. In such a case,
the success of the implant may be jeopardised by the increased strains
in the alveolar region that can lead to periimplantitis, atrophy and
finally to implant failure. From this point of view, it is necessary to take
into account the whole bone morphology and to be assured that
cancellous bone surrounds the whole surface of the implant.
Fig. 4 shows that the displacements are, in general, lower in the
models with a 0.1 mm-thick BIC around the whole surface of the
implant. This observation is related to the phenomenon discussed
in the previous paragraph. A bony layer around the implant
ensures implant stability more than anything else. For successful
implantation, it is essential that this layer is created during the
healing process. This fact, however, cannot be confirmed only from
implant displacements.
The axial displacements of the Brånemark and Ankylos imp-
lants applied in the same bone segments are comparable (parti-
cularly in the cases of bone segments of higher BVF). The axial
displacements of the Straumann implant are higher than the
previous ones applied in the same bone segments. Nevertheless,
as explained above, this observation does not mean that one
implant type has better implant stability than the other.
The implant displacements in the order of several micrometres
that were observed in this study correspond to experimental
observations (Sekine et al., 1986).
3834 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836
Fig. 5. Strain intensity [με] results - bone sample 0.149F(39), 0.377M(67), 0.401M(75).
4.2. Strain intensity
The strain intensity results revealed significant differences
between the models with various BVF (Figs. 5 and 6). In general,
the higher BVF is, the lower the strain intensity that occurs. The
overall morphology of the analysed region, however, must again
be taken into account. For instance, in the case of F(39), most of
the excessive strain concentrations occurred in the cortical bone of
the alveolar region. On one hand, the connection with the cortical
bone increases the stiffness (thus the apparent implant stability);
on the other hand, this connection causes a deficient loading of the
few trabeculae that should primarily establish the implant stabi-
lity. The deficient loading of the cancellous bone leads to its
atrophy. Therefore, the case of F(39) represents the unacceptable
state for implantation.
Implant stability is also affected by the quality of the individual
trabeculae. Interestingly, the trabeculae are the most strained a few
millimetres from the implants and not necessarily in the direct
proximity of the implants (see also Fig. 7). This observation is
consistent with experiments previously performed by Gabet et al.,
2010. In terms of the biomechanical behaviour, one of the decisive
criteria is the shape (cross-section) of the individual trabeculae. For
instance, case M(67) has a relatively well distributed trabecular
architecture around the implant; however, many trabeculae here
are thin and with strongly variable cross-sectional area along their
length. Such trabeculae may, therefore, contain locations where
the loads are excessively concentrated and this may lead to the
destruction of the trabeculae. In the long term, the bone remodelling
processes may eliminate these problematic locations naturally.
However, this is the case only provided that the implant is embedded
in a sufficient amount of cancellous bone and that the additional
bony layer is created around the whole implant during the healing
process. In other cases, the excessive loading of one single trabecula
may start a snowball effect that will end with the critical decrease of
the BVF due to the pathological overload and will result in implant
failure. Such high strains can in some cases also lead to tissue
necrosis. (red zone – pathological overloaded).
4.3. Thread patterns
Considering the wide range of implant geometries on the market,
a better understanding of the effect of macro-configuration on
induced strains is an important issue for clinical success. All implants
used in this study had distinctly different thread patterns: Brånemark
a V-thread, Ankylos a square thread, and Straumann a reverse
buttress thread. According to several studies (Hansson and Werke,
2003 and Huang et al., 2010), implant threads generate different
strain distribution patterns under axial loading, that is, according to
these studies a thread shape can markedly influence the strain
transferred to the surrounding bone. The results of our study revealed
that the three different dental implants generated different strain
distributions. The Brånemark implant system demonstrated the most
uniform distribution of strain followed by the Ankylos implant.
However, the Straumann implant used in the analysis has a smaller
diameter than the other implants. Since implant size is a decisive
factor as well, the appropriate implant diameter must be thoroughly
considered prior to implantation. Even though no detailed analysis of
the thread pattern influence on the strain distribution was performed
 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836 3835

Fig. 6. Strain intensity [με] results - bone sample; 0.433F(47), 0.466F(59), 0.471M(58).

in this study, the results revealed that strain distributions are fore-
most dependent on the bone shape and trabecular architecture of
cancellous bone.
We suppose that the FEA method described in this study
should be adopted for clinical use in the future. However, it is
not possible to analyse the issues discussed in this study using
models without the detailed trabecular architecture. Our study
shows that computational analyses of implant stability require a
3-dimensional geometrical model of the detailed architecture. This
could be easily done by preoperatively converting patient-specific
X-ray data (DICOM) into STL's and merging them with STL's of
different commercially-available dental implants. This would offer
the clinician a unique possibility to preoperatively assess the strain
distribution of different implant systems on patient-specific bone.
This in vitro study has certain limitations in that the different
masticatory forces induced on implants in clinical settings differ
from those that are induced under static loading conditions.
Another major drawback of this study was that dental implants
are often used in conjunction with remaining natural teeth.
Natural teeth behave very differently in response to different
masticatory forces due to periodontal ligament fibres. The dis-
placements of implants are substantially lower than the displace-
ments of healthy teeth (Amarsaikhan et al., 2002 and Sekine et al.,
1986). Therefore, the calculated values in this study should not be
taken as absolute values but at most as relative values of stresses
in structures under static loading.
Based on the results of the study, it can be concluded that the
level of bone atrophy, implant geometries and thread patterns have
an influence on strain distribution in the mandible. Furthermore, the Fig. 7. Detailed examples of strain intensity [mε] results – 0.149F(39), a) and 0.377M(67).
3836 P. Marcián et al. / Journal of Biomechanics 47 (2014) 3830–3836
BIC level plays a crucial role in implant stability and that strain
distributions are foremost dependent on the bone shape and
trabecular architecture of cancellous bone. Preoperative finite ele-
ment analysis (FEA) using patient-specific X-ray image data could
offer additional predictability in the long-term outlook of dental
implant restorations.
Conflict of interest statement
The authors have no conflict of interest.
Acknowledgements
This work is an output of cooperation between CEITEC - Central
European Institute of Technology (CZ.1.05/1.1.00/02.0068), specific
research FSI-S-14-2344 and NETME Centre, regional R&D centre
built with the financial support from the Operational Programme
Research and Development for Innovations within the project
NETME Centre (New Technologies for Mechanical Engineering),
Reg. No. CZ.1.05/2.1.00/01.0002 and, in the follow-up sustainability
stage, supported through NETME CENTRE PLUS (LO1202) by
financial means from the Ministry of Education, Youth and Sports
under the National Sustainability Programme I. We would like to
acknowledge Miloslav Drápela from the MCAE systems company
for his help with the preparation of the FE models.
References
Achour, T., Merdji, A., Bachir, B., Bouiadjra, B., Serier, N., Djebbar, N., 2011. Stress
distribution in dental implant with elastomeric stress barrier. Mater. Design
32, 282–290.
Al-Sukhun, J., Kelleway, J., Helenius, M., 2007. Development of a three-dimensional
finite element model of a human mandible containing endosseous dental
implants I. Mathematical validation and experimental verification. J. Biomed.
Mater. Res A 80, 234–246.
Amarsaikhan, B., Miura, H., Okada, D., Masuda, T., Ishihara, H., Shinki, T., Kanno, T.,
2002. Influence of environmental factors on tooth displacement. J. Med. Dent.
Sci. 49, 19–26.
Asvanund, P., Morgano, S.M., 2011. Photoelastic stress analysis of external versus
internal implant-abutment connections. J. Prosthet. Dent. 106, 266–271.
Bozkaya, D., Muftu, S., Muftu, A., 2004. Evaluation of load transfer characteristics of
five different implants in compact bone at different load levels by finite
elements analysis. J. Prosthet. Dent. 92, 523–530.
Bujtár, P., Sándor, G.K., Bojtos, A., Szucs, A., Barabás, J., 2010. Finite element analysis
of the human mandible at 3 different stages of life. Oral Surg. Oral Med. Oral
Pathol. Oral Radiol. Endod. 110, 301–309.
Field, C., Li, Q., Li, W., Thompson, M., Swain, M., 2012. A comparative mechanical
and bone remodelling study of all-ceramic posterior inlay and onlay fixed
partial dentures. J. Dent. 40, 48–56.
Frost, H.M., 2001. From Wolff's law to the Utah paradigm: Insights about bone
physiology and its clinical applications. Anat. Rec. 262, 398–419.
Frost, H.M., 2004. A 2003 update of bone physiology and Wolff's law for clinicians.
Angle Orthod. 74, 3–15.
Gabet, Y., Kohavi, D., Voide, R., Mueller, T.L., Müller, R., Bab, I., 2010. Endosseous
implant anchorage is critically dependent on mechanostructural determinants
of peri-implant bone trabeculae. J. Bone Miner. Res. 25, 575–583.
Gei, M., Genna, F., Bigoni, D., 2002. An interface model for the periodontal ligament.
J. Biomech. Eng. 124, 538–546.
Geng, J.P., Tan, K.B., Liu, G.R., 2001. Application of finite element analysis in implant
dentistry: a review of the literature. J. Prosthet. Dent. 85, 585–598.
Hansson, S., Werke, M., 2003. The implant thread as a retention element in cortical
bone: the effect of thread size and thread profile: a finite element study.
J. Biomech. 36, 1247–1258.
Huang, H.L., Hsu, J.T., Fuh, L.J., Lin, D.J., Chen, M.Y.C., 2010. Biomechanical simulation
of various surface roughnesses and geometric designs on an immediately
loaded dental implant. Comput. Biol. Med. 40, 525–532.
Kayabaşi, O., Yüzbasioğlu, E., Erzincanli, F., 2006. Static, dynamic and fatigue
behaviors of dental implant using finite element method. Adv. Eng. Softw.
37, 649–658.
Kohles, S., Bowers, J., Vailas, A., 1997. Ultrasonic wave velocity measurement in
small polymeric and cortical bone specimens. J. Biomech. Eng. 119, 232–236.
Lan, T.H., Du, J.K., Pan, C.Y., Lee, H.E., Chung, W.H., 2012. Biomechanical analysis of
alveolar bone stress around implants with different thread designs and pitches
in the mandibular molar area. Clin. Oral Invest. 16, 363–369.
Lanyon, L.E., 1992. Control of bone architecture by functional load bearing. J. Bone
Miner. Res. 7, 369–375.
Limbert, G., van Lierde, C., Muraru, O.L., Walboomers, X.F., Frank, M., Hansson, S.,
Middleton, J., Jaecques, S., 2010. Trabecular bone strains around a dental
implant and associated micromotions-A micro-CT-based three-dimensional
finite element study. J. Biomech. 43, 1251–1256.
Lin, D., Li, Q., Li, W., Duckmanton, N., Swain, M., 2010. Mandibular bone remodeling
induced by dental implant. J. Biomech. 43, 287–293.
Liu, J., Pan, S., Dong, J., Mo, Z., Fan, Y., Feng, H., 2013. Influence of implant number on
the biomechanical behaviour of mandibular implant-retained/supported over-
dentures: A three-dimensional finite element analysis. J. Dent. 41, 241–249.
Martin, R., Burr, D.B., 1989. Structure, Function, and Adaptation of Compact Bone.
Raven Press, New York.
Mellal, A., Wiskott, H.W., Botsis, J., Scherrer, S.S., Belser, U.C., 2004. Stimulating
effect of implant loading on surrounding bone. Comparison of three numerical
models and validation by in vivo data. Clin. Oral Implan. Res. 15, 239–248.
Menicucci, G., Mossolov, A., Mozzati, M., Lorenzetti, M., Preti, G., 2002. Tooth-
implant connection: some biomechanical aspects based on finite element
analyses. Clin. Oral Implan. Res. 13, 334–341.
Morgan, M.J., James, D.F., Pilliar, R.M., 1993. Fractures of the fixture component of
an osseointegrated implant. Int. J. Oral Max. Impl. 8, 409–414.
Natali, A.N., Pavan, P.G., Ruggero, A.L., 2006. Analysis of bone–implant interaction
phenomena by using a numerical approach. Clin. Oral Impl. Res. 17, 67–74.
Natali, A.N., Carniel, E.L., Pavan, P.G., 2008. Investigation of bone inelastic response
in interaction phenomena with dental implants. Dent. Mater. 24, 561–569.
Ormianer, Z., Amar, A.B., Duda, M., Marku-Cohen, S., Lewinstein, I., 2012. Stress and
strain patterns of 1-piece and 2-piece implant systems in bone: a
3-dimensional finite element analysis. Implan. Dent. 21, 39–45.
Özdemir Doğan, D., Polat, N.T., Polat, S., Seker, E., Gül, E.B., 2014. Evaluation of “All-
on-Four” concept and alternative designs with 3D finite element analysis
method. Clin. Impl. Dent. Rel. Res. 16, 501–510.
Petrie, C.S., Williams, J.L., 2005. Comparative evaluation of implant designs:
influence of diameter, length, and taper on strains in the alveolar crest.
A three-dimensional finite-element analysis. Clin. Oral Impl. Res. 16, 486–494.
Quirynen, M., Naert, I., van Steenberghe, D., 1992. Fixture design and overload
influence marginal bone loss and fixture success in the Branemarks system.
Clin. Oral Impl. Res. 3, 104–111.
Rho, J.Y., Tsui, T.Y., Pharr, G.M., 1997. Elastic properties of osteon and trabecular
bone measured by nanoindentation. J. Biomech. 31 (21–21).
Roberts, W.E., 2008. Bone physiology, metabolism, and biomechanics. In: Misch,
C.E. (Ed.), Contemporary Implant Dentistry, third ed. Mosby Elsevier, St. Louis,
pp. 557–598.
Rubin, C.T., Lanyon, L.E., 1985. Regulation of bone mass by mechanical strain
magnitude. Calcified Tissue Int. 4, 411–417.
Rubo, J.H., Capello Souza, E.A., 2010. Finite-element analysis of stress on dental
implant prosthesis: a histomorphometric and biomechanical analysis. Clin.
Impl. Dent. Rel. Res. 12, 105–113.
Saidin, S., Abdul Kadir, M.R., Sulaiman, E., Abu Kasim, N.H., 2012. Effects of different
implant–abutment connections on micromotion and stress distribution: pre-
diction of microgap formation. J. Dent. 40, 467–474.
Sarrafpour, B., Rungsiyakull, C., Swain, M., Li, Q., Zoellner, H., 2012. Finite element
analysis suggests functional bone strain accounts for continuous post-eruptive
emergence of teeth. Arch. Oral Biol. 57, 1070–1078.
Sekine, H., Komiyama, Y., Hotta, H., Yoshida, K., 1986. Mobility characteristics and
tactile sensitivity of osseointegrated fixture-supporting systems. In: van Steen-
berghe, D. (Ed.), Tissue Integration in Oral and Maxillofacial Reconstruction.
Elsevier, Amsterdam, pp. 326–339.
Sennerby, L., Meredith, N., 2008. Implant stability measurements using resonance
frequency analysis: biological and biomechanical aspects and clinical implica-
tions. Periodontology 2000 (47), 51–66.
Soncini, M., Pietrabissa, R.P., Natali, A.N., Pavan, P.G., Williams, K.R., 2003. Testing
the reliability of dental implant device. In: Natali, A.N. (Ed.), Dental Biomecha-
nics, first ed. Taylor & Francis, London, pp. 111–127.
Turner, C.H., Rho, J., Takano, Y., Tsui, T.Y., Pharr, G.M., 1999. The elastic properties of
trabecular and cortical bone tissues are similar: results from two microscopic
measurement techniques. J. Biomech. 32, 437–441.
Van Oosterwyck, H., Duyck, J., Vander Sloten, J., Van der Perre, G., Naert, I., 2002.
Peri-implant bone tissue strains in cases of dehiscence: a finite element study.
Clin. Oral Impl. Res. 13, 327–333.
Van Steenberghe, D., Jacobs, R., Desnyder, M., Maffei, G., Quirynen, M., 2002. The
relative impact of local and endogenous patient-related factors on implant
failure up to the abutment stage. Clin. Oral Impl. Res. 13, 617–622.
Wirth, A.J., Müller, R., van Lenthe, G.H., 2010. Computational analyses of small
endosseous implants in osteoporotic bone. Eur. Cells. Mater. 21, 58–67.
Wirth, A.J., Müller, R., van Lenthe, G.H., 2012. The discrete nature of trabecular bone
microarchitecture affects implant stability. J. Biomech. 45, 1060–1067.
Wolff, J.D., 1892. Das Gesetz der Transformation der Knochen. Hirschwald, Berlin.