Biomechanical aspects in dental replacements

This chapter deals with biomechanical aspects in dental replacements. The state of the art is critically reviewed taking into account the body of the literature results. The initial section is devoted to the mechanical properties of bone and to a description of the jaw geometry and of its loading and constraining. The following section presents a classifi cation of the various tooth replacement confi gurations and of the various materials adopted, where single and multiple replacements are considered. A specifi c section is devoted to the solid modelling of the jaw as input to numerical analyses, where the aid offered by reverse engineering and tomography is underlined. The fi nite element method as well as alternative numerical and experimental approaches are reviewed in a dedicated section. The stress analysis forecasts and measurements are biomechanically interpreted in the light of the current literature results. The chapter ends with a section devoted to biological aspects

Biomechanics and Remodelling for Design and Optimisation in Oral Prosthesis and Therapeutical Procedure

The purpose of dental prostheses is to restore the oral function for edentulous patients. Introducing any dental prosthesis into mouth will alter biomechanical status of the oral environment, consequently inducing bone remodelling. Despite the advantageous benefits brought by dental prostheses, the attendant clinical complications and challenges, such as pain, discomfort, tooth root resorption, and residual ridge reduction, remain to be addressed. This thesis aims to explore several different dental prostheses by understanding the biomechanics associated with the potential tissue responses and adaptation, and thereby applying the new knowledge gained from these studies to dental prosthetic design and optimisation. Within its biomechanics focus, this thesis is presented in three major clinical areas, namely prosthodontics, orthodontics and dental implantology. In prosthodontics, the oral mucosa plays a critical role in distributing occlusal forces a denture to the underlying bony structure, and its response is found in a complex, dynamic and nonlinear manner. It is discovered that interstitial fluid pressure in mocosa is the most important indicator to the potential resorption induced by prosthetic denture insertion, and based on this finding, patient-specific analysis is performed to investigate the effects caused by various types of dentures and prediction of the bone remodelling activities. In orthodontic treatments, a dynamic algorithm is developed to analyse and predict potential bone remodelling around the target tooth during orthodontic treatment, thereby providing a numerical approach for treatment planning. In dental implantology, a graded surface morphology of an implant is designed to improve osseointegration over that of a smooth uniform surface in both the short and long term. The graded surface can be optimised to achieve the best possible balance between the bone-implant contact and the peak Tresca stress for the specific clinical application need

Design and manufacture of a customised temporomandibular prosthesis

In this work, design, manufacture and surgical success of a personalised temporomandibular prosthesis is featured. A fused deposition modelling technique and Die forging process constitute the methodology used in a patient who had an amputation in the upper third branch of the mandible, without considering the joint capsule. The implant was designed using a processed resection image of a computational tomography and using the methodology of Özkaya and Nordin. The jaw operating conditions were simulated by the finite element method (FEM). The main considered factors were the morphological geometry of the patient, implant fixation in the first third of the branch, implant fixation on the chin, dental post for placement of the teeth, and the form of the sub-lingual fossa weight optimisation. Special consideration was to preserve the patients facial aesthetics.Peer Reviewe

Patient-specific finite element models of the human mandible:Lack of consensus on current set-ups

The use of finite element analysis (FEA) has increased rapidly over the last decennia and has become a popular tool to design implants, osteosynthesis plates and prostheses. With increasing computer capacity and the availability of software applications, it has become easier to employ the FEA. However, there seems to be no consensus on the input variables that should be applied to representative FEA models of the human mandible. This review aims to find a consensus on how to define the representative input factors for a FEA model of the human mandible. A literature search carried out in the PubMed and Embase database resulted in 137 matches. Seven papers were included in this current study. Within the search results, only a few FEA models had been validated. The material properties and FEA approaches varied considerably, and the available validations are not strong enough for a general consensus. Further validations are required, preferably using the same measuring workflow to obtain insight into the broad array of mandibular variations. A lot of work is still required to establish validated FEA settings and to prevent assumptions when it comes to FEA applications

Explore the Dynamic Characteristics of Dental Structures: Modelling, Remodelling, Implantology and Optimisation

The properties of a structure can be both narrowly and broadly described. The mechanical properties, as a narrow sense of property, are those that are quantitative and can be directly measured through experiments. They can be used as a metric to compare the benefits of one material versus another. Examples include Young’s modulus, tensile strength, natural frequency, viscosity, etc. Those with a broader definition, can be hardly measured directly. This thesis aims to study the dynamic properties of dental complex through experiments, clinical trials and computational simulations, thereby bridging some gaps between the numerical study and clinical application. The natural frequency and mode shapes, of human maxilla model with different levels of integrities and properties of the periodontal ligament (PDL), are obtained through the complex modal analysis. It is shown that the comprehensiveness of a computational model significantly affects the characterisation of dynamic behaviours, with decreasing natural frequencies and changed mode shapes as a result of the models with higher extents of integrity and preciseness. It is also found that the PDL plays a very important role in quantifying natural frequencies. Meanwhile, damping properties and the heterogeneity of materials also have an influence on the dynamic properties of dental structures. The understanding of dynamic properties enables to further investigate how it can influence the response when applying an external stimulus. In a parallel preliminary clinical trial, 13 patients requiring bilateral maxillary premolar extractions were recruited and applied with mechanical vibrations of approximately 20 g and 50 Hz, using a split mouth design. It is found that both the space closure and canine distalisation of the vibration group are significantly faster and higher than those of the control group (p<0.05). The pressure within the PDL is computationally calculated to be higher with the vibration group for maxillary teeth for both linguo-buccal and mesial-distal directions. A further increased PDL response can be observed if increasing the frequency until reaching a local natural frequency. The vibration of 50 Hz or higher is thus approved to be a potential stimulus accelerating orthodontic treatment. The pivotal role of soft tissue the PDL is further studied by quantitatively establishing pressure thresholds regulating orthodontic tooth movement (OTM). The centre of resistance and moment to force ratio are also examined via simulation. Distally-directed tipping and translational forces, ranging from 7.5 g to 300 g, are exerted onto maxillary teeth. The hydrostatic stress is quantified from nonlinear finite element analysis (FEA) and compared with normal capillary and systolic blood pressure for driving the tissue remodelling. Localised and volume-averaged hydrostatic stress are introduced to describe OTM. By comparing with clinical results in past literature, the volume average of hydrostatic stress in PDL was proved to describe the process of OTM more indicatively. Global measurement of hydrostatic pressure in the PDL better characterised OTM, implying that OTM occurs only when the majority of PDL volume is critically stressed. The FEA results provide new insights into relevant orthodontic biomechanics and help establish optimal orthodontic force for a specific patient. Implant-supported fixed partial denture (FPD) with cantilever extension can transfer excessive load to the bone surrounding implants and stress/strain concentration which potentially leads to bone resorption. The immediate biomechanical response and long-term bone remodelling outcomes are examined. It is indicated that during the chewing cycles, the regions near implant necks and apexes experience high von Mises stress (VMS) and equivalent strain (EQS) than the middle regions in all configurations, with or without the cantilever. The patient-specific dynamic loading data and CT based mandibular model allow us to model the biomechanical responses more realistically. The results provide the data for clinical assessment of implant configuration to improve longevity and reliability of the implant-supported FPD restoration. On the other hand, the results show that the three-implant supported and distally cantilevered FPDs see noticeable and continuous bone apposition, mainly adjacent to the cervical and apical regions. The bridged and mesially cantilevered FPDs show bone resorption or no visible bone formation in some areas. Caution should be taken when selecting the FPD with cantilever due to the risk of overloading bone resorption. The position of FPD pontics plays a critical role in mechanobiological functionality and bone remodelling. As an important loading condition of dental biomechanics, the accurate assignment of masticatory loads has long been demanded. Methods involving different principles have been applied to acquire or assess the muscular co-activation during normal or unhealthy stomatognathic functioning. Their accuracy and capability of direct quantification, especially when using alone, are however questioned. We establish a clinically validated Sequential Kriging Optimisation (SKO) model, coupled with the FEM and in vivo occlusal records, to further the understanding of muscular functionality following a fibula free flap (FFF) surgery. The results, within the limitations of the current study, indicates the statistical advantage of agreeing occlusal measurements and hence the reliability of using the SKO model over the traditionally adopted optimality criteria. It is therefore speculated that mastication is not optimally controlled to a definite degree. It is also found that the maximum muscular capacity slightly decreases whereas the actual muscle forces fluctuate over the 28-month period

Stress Analysis of an Endosseus Dental Implant by BEM and FEM

In this work the Boundary Element Method (BEM) and the Finite Element Method (FEM) have been used for an elastic-static analysis of both a Branemark dental implant and a generic conic threaded implant, modelled either in the complete mandible or in a mandibular segment, under axial and lateral loading conditions. Two different hypotheses are considered with reference to degree of osteo-integration between the implant and the mandibular bone: perfect and partial osteointegration. The BEM analysis takes advantage of the submodelling technique, applied on the region surrounding the implant. Such region is extracted from the overall mandible and the boundary conditions for such submodel are obtained from the stress analysis realised on the complete mandible. The obtained results provide the localisation of the most stressed areas at the bone-implant interface and at the mandibular canal (containing the alveolar nerve) which represent the most critical areas during mastication. This methodology, enriched with the tools necessary for the numerical mandible reconstruction, is useful to realise sensitivity analysis of the stress field against a variation of the localisation, inclination and typology of the considered implant, in order to assess the optimal implant conditions for each patient under treatment. Due to the high flexibility in the pre- and post-processing phase and accuracy in reproducing superficial stress gradients, BEM is more efficient than FEM in facing this kind of problem, especially when a linear elastic constitutive material law is adopted

Stochastically generated finite element beam model for dental research

Dental implantation is currently the most commonly used and physiologically the most favourable procedure for tooth replacement in dental surgery. Implants can have either advantageous or destructive effect on the surrounding bone, depending on several physiological, material and mechanical factors. The most general method for estimating the biomechanical behaviour of the bone is Finite Element Analysis. The microstructural conformation of the trabecular bone - which can be modelled by the means of converting computed tomography images into micro finite element models or in a stochastic way - influences the overall mechanical properties of the bone tissue. To avoid the use of computer tomography imaging and to create a repeatable and variable finite element model, a stochastically generated beam structure was accomplished that possesses the geometrical and mechanical microstructural properties - obtained from literature - of the trabecular bone substance of an average man from the edentulous mandibular re gion. The finite element beam model was submitted to compression tests, and the macro-structural elastic properties were computed from the result data obtained by the means of Finite Element Analysis. Several attempts have been made to achieve the possibly most accurate elastic properties. Considering the shell behaviour of the trabeculae by dividing each beam into three parts with different elastic properties proved to be the most effective and the most suitable for further investigations, in which different types of loading and the finite element model of an implant embedded in the bone is planned to be used

Stress Distribution on Edentulous Mandible and Maxilla Rehabilitated by Full-Arch Techniques: A Comparative 3D Finite-Element Approach

In this paper biomechanical interaction between osseointegrated dental implants and bone is numerically investigated through 3D linearly elastic finite-element analyses, when static functional loads occur. Influence of some mechanical and geometrical parameters on bone stress distribution is highlighted and risk indicators relevant to critical overloading of bone are introduced. Insertions both in mandibular and maxillary molar segments are analyzed, taking into account different crestal bone loss configurations. Stress-based performances of five commercially-available dental implants are evaluated, demonstrating as the optimal choice of an endosseous implant is strongly affected by a number of shape parameters as well as by anatomy and mechanical properties of the site of placement. Moreover, effectiveness of some double-implant devices is addressed. The first one is relevant to a partially edentulous arch restoration, whereas other applications regard single-tooth restorations based on non-conventional endosteal mini-implants. Starting from computer tomography images and real devices, numerical models have been generated through a parametric algorithm based on a fully 3D approach. Furthermore, effectiveness and accuracy of finite-element simulations have been validated by means of a detailed convergence analysis