Proceedings of the IMProVe 2011 International conference on Innovative Methods in Product Design th th June 15 17 , 2011, Venice, Italy

Studying the influence of thread features in osseo-integrated implants

P. Franciosa
(a) (b)

(a)

, M. Martorelli

(b)

University of Molise, School of Engineering University of Naples, Federico II, School of Engineering

Article Information
Keywords:
Thread parameterisation Osseo-integration FE modelling DOE design Bone-stress distribution

Abstract
Purpose:
The present paper investigates the influence of implant design factors in terms of bone integrity and implant stability.

Method:
First of all, a 3D parametric CAD model was developed. Then, by defining domain settings and boundary conditions, a 3D FE model was created, accordingly. In order to simulate as well as possible the physical interaction at bone-implant interface, identity pairs were introduced. After generating different design scenarios with a DOE approach, the most significant design factors were obtained.

Corresponding author:
Massimo Martorelli Tel.: +39 081 7682470 Fax.: +39 081 7682470 e-mail: massimo.martorelli@unina.it Address: P. le Tecchio, 80, 80125, Naples - Italy

Result:
Finding of this research showed that the geometry of the screw-thread highly influences the implant stability. More specifically, thread-width and -tick assume a crucial role to reduce bone induced stresses and bone damage.

Discussion & Conclusion:

Starting from these preliminary results, future improvements will focus on investigating also two-factor and higher interactions to better understand the implant loading mechanism.

1 Introduction
Dental implantology is a set of surgical techniques allowing to obtain, by using dental implants, the functional rehabilitation of a patient affected by partial or total edentulism. Dental implants can have different shapes, they can be inserted in different positions, and they remain incorporated in the patients bone by physiological bone regeneration actions. It was reported that osseo-integration is affected by many factors, including the implant design, surface treatment, bone quality, surgical technique, post-operative care [1]. Among these, the thread design of an implant is one of the dominant factors. In particular, the total contact area between the implant and bone plays a significant role in the osseo-integration strength of implant-bone interfaces [2]. In addition, the design of the implant threads directly affects the stress distribution and the marginal bone restoration [3]. Over the years many experimental and clinical reports revealed that the first thread is the most stressed site, and thus the initial micro-fracture and eventually immature osseo-integration occur at this site. There are various commercial solutions for dental implants. Their designs are quite differ in terms of thread shape. Recent researches have focused on studying the influence and the sensitivity of the implant features: thread-pitch, -depth, -width, -helix angle, among others. Understanding these factors and applying them appropriately in the science of dental implants can help in reducing the potential implant failure.

An appreciable overview of the effects of implant geometrical features on osseo-integration was reported in [4]. Authors pointed-out that a valid and valuable support in clinical and in vivo/vitro investigations is offered by numerical FEA simulations. In these terms, when facingout analyses of sensitivity on different design setting, FE modelling becomes a valid support. Many studies, mainly based on FEM approaches, have been conducted to study the influence of different design implants. A valid contribution was done in [5], where by using a parametric FE model the sensitivity of thread pitch and width was studied. A very interesting research was conducted by [6], who concluded that the most favourable configuration, in terms of implant stability, is the singlethreaded one, followed by the double threaded. The triple threaded was found to be the less stable. One critical aspect to consider is how to "quantify" the stability of a dental implant. In [7] authors used the contact area as measure of the stability. They found that higher the contact area, less the bone damage. A more quantitative approach was suggested in [8], where the implant failure was associated to the maximum normal stress criterion. Experimental tests were also conducted to measure the ultimate bone strength. In agreement with a number of studies [9] the von Mises stress field was used as an indicator of the average stress level at the bone-implant region, providing a global measure of the load transfer mechanism. Very often, FE models have been generated under some assumptions. Over all, 2D axial-symmetric models have been widely adopted since they allow to reach fast and accurate results and to perform quite easily
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P. Franciosa and M. Martorelli

Studying the influence of thread features in osseo-integrated implants

parametric analyses. In [10], authors used a 2D axialsymmetric model to point-out the difference among different commercial design, accounting both perfect and not- perfect osseo-integration. Apart from the advantages of 2D axial-symmetric models, they are not able to rightly capture some phenomena which may arise at boneimplant interface. In fact, the loading mechanism can be strongly affected by screw-helix angle and also by out-ofplane stress components [4]. Starting from the literature review, the present paper investigates the influence of some implant features. First of all, a 3D parametric CAD model of a dental implant was developed. Then, a FE model was created, by defining domain settings and boundary conditions. By adopting a DOE approach, different implant designs were automatically generated and for each of them a FE solution was obtained. By statistically analysing numerical results, the most influencing implant features were observed and discussed.

2 Materials and methods

In order to quickly analyze different design settings, a parametric CAD model of a dental implant (fig. 1) was created into SolidWorks 2010 (by Dassault Systemes) CAD system.

cortical bone

The bone structure was modelled by a cylinder block (diameter and length equal to 15 mm and 20 mm, respectively). The cortical bone thickness was assumed constant and equal to 2 mm, as also suggested into [8]. The implant model was parameterised by introducing the following geometric parameters (see fig. 2): diameter ("dI") and length ("LI"); bone-implant interface length (Lt); thread-pitch ("p"), -width ("w"), -tick ("t"); and, upper (1) and lower (2) thread-angles. Notice that the thread-angle is the angle between a face of a thread and a plane perpendicular to the longitudinal axis of the same implant. The following hypotheses were formulated: the abutment is "rigidly" connected to the implant. Its length is Li-Lt. The occlusal load is applied on the upper surface of the abutment. Notice that for some commercial solutions [11], the abutment is joined to the implant with an internal screw (not modelled here); the implant diameter is assumed constant and equal to dI=4 mm. Commercial solutions provide both cylindrical or conical implant. In the present research a cylindrical shape is assumed; a single threaded implant is considered; the mechanical behaviour of the bone structure is captured with a linear isotropic law. This assumption approximates a type II bone quality [8]; and, perfect osseo-integration is accounted. In order to assure the right correspondence at boneimplant interface, a boolean operation was performed, by subtracting the implant from the bone structure. Fig. 1 depicts the so-modelled implant/bone geometry.
level/factor 1 2 3 4 p (mm) 0,90 0,95 1,00 1,10 w (mm) 0,35 0,40 0,45 0,50 t (mm) 0,05 0,10 0,15 0,20 1 () 5,00 10,00 20,00 30,00 1 () 5,00 10,00 20,00 30,00

implant

trabecular bone

Fig. 1 Bone and implant CAD models

Although accurate detailed anatomical geometry may be obtained from CT scans, a simplified bone geometry was here accounted. Final numerical results will not be affected by this assumption since the main aim of this study is performing a sensitivity analysis among different implant features (not varying the bone geometry).
dI

Tab. 1 Design factors and their levels Treatment ID I II III IV V VI VII VIII IX X p 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 w 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 t 1 2 3 4 2 1 4 3 3 4 1 2 4 3 2 1 1 1 2 3 4 3 4 1 2 4 3 2 1 2 1 4 3 2 1 2 3 4 4 3 2 1 2 1 4 3 3 4 1 2

LI 1 2 p t w Lt

XI XII XIII XIV XV XVI

Tab. 2 Adopted fractional factorial array L16 Fig. 2 Implant design factors June 15th 17th, 2011, Venice, Italy

In the present paper we aim to study the sensitivity of

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Studying the influence of thread features in osseo-integrated implants

some thread features (here called "design factors") on implant stability. For this purpose we assumed that a qualitative measure of the implant stability can be obtained by evocating the maximum stress criterion: that is, higher the maximum stress at bone-implant interface, lower the implant stability. In the following such a criterion will be named "Implant STability index" (I-STI). Therefore, the proposed approach may be summarized as follows: (I) generate a set of combinations of design factors by using a DOE approach; (II) calculate the stability index for every combination by solving a FE

model; and, then, (III) analyze design scenarios, looking for the influence of design factors. Among geometric parameters, five design factors were considered: p, w, t, 1 and 2. Tab. 1 reports adopted levels (shortly named "1", "2", "3" and "4"). A full factorial design would require a large amount of 5 tests (4 = 1024). However, in this array design only 5 of the 1024 degrees of freedom [12] correspond to main effects, and only 10 degrees of freedom are related to two-factor interactions. The remaining degrees of freedom correspond to three-factor and higher interactions.

II

III

I V

VI

VII

VIII

IX

XI

XII

XIII

XIV

XV

XVI

Tab. 3 Implant designs generated according to the fractional factorial array L 16

Fig. 3 FE model and boundary conditions

b - bone-implant interface

a - FE model

c - bones interface

Therefore, since it is reasonable that only main effects or two-factor interactions are significant, a fractional design array, L16, was adopted. Notice that if on one hand this array requires only 16 tests, on the other hand aliasing effects may arise. Tab. 2 reports the adopted L16 array. Tab. 3 depicts implant geometry configurations, according to the L16 array and generated into SolidWorks CAD system, starting from the parametric CAD model. FEM simulations were performed within Comsol Multiphysics 3.5a. Same domain settings and boundary conditions were applied for the 16 geometry configurations. As example, fig. 3 depicts the FE model related to geometry configuration III. Tetrahedral mesh elements were generated. Looking at fig. 3.a notice how mesh size was strongly reduced (about 0.1 mm) around implant-bone interface, where the highest stresses are expected. The total number of elements was 148102, while the number of mesh nodes was 34174. Linear shape functions were adopted to interpolate node displacements. Therefore, the number of degrees of freedom solved for was 102522. Materials were considered linear and isotropic. Tab. 4 summarise adopted mechanical properties (E - Young's Modulus, - Poisson's ratio). Implants and abutments were assumed to be made of a titanium alloy (Ti 6Al-4V). Boundary conditions are depicted into figs. 3.b and 3.c.
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P. Franciosa and M. Martorelli

Studying the influence of thread features in osseo-integrated implants

The lower surface of the trabecular bone was fixed. Moreover, a static load (350 N), simulating the occlusal force, was applied at the upper surface of the abutment. This force formed an angle of 12 with respect to the implant axis.
E (GPa) Implant Cortcal bone i Trabecular bone 120.0 13.7 0.50 0.33 0.30 0.30

Tab. 4 Adopted mechanical properties [8]

The physical interaction of implant-bone and cortical bone-trabecular bone interfaces was captured by introducing identity pairs (coloured surfaces into fig. 3.b and 3.c). Identity pairs assure that the displacement field at interfacial surfaces are identical each-other. In agreement with the maximum normal stress criterion (also known as Coulomb criterion), principal stresses were used at the bone-implant interface to define a measure of the implant stability. Experimental tests [13] estimated that local overloading at cortical bone occurs in
Treatment ID I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI p 0.90 0.90 0.90 0.90 0.95 0.95 0.95 0.95 1.00 1.00 1.00 1.00 1.10 1.10 1.10 1.10 w 0.35 0.40 0.45 0.50 0.35 0.40 0.45 0.50 0.35 0.40 0.45 0.50 0.35 0.40 0.45 0.50 t 0.05 1 5.00 2 5.00

compression when the maximum compressive principal stress (C) exceeds 30 MPa (in modulus), and in tension when the maximum tensile principal stress (T) exceeds 60 MPa. Moreover, local overloading at the trabecular bone occurs when T and/or C (in modulus) exceed 5 MPa. The maximum stress criterion was implemented as follows: (I) stress distributions were calculated by using the FE model. (II) The region, where the maximum principle normal stress exceeds the ultimate bone strength, was identified, and (III) the corresponding volume was calculated: this is the implant stability index (ISTI). The implant stability index can be easily implemented and calculated into Comsol Multiphysics by using domain expressions and integration coupling variables.

3 Results
Tab. 5 reports I-STi indexes calculated for trabecular and cortical bones. Fig. 4 depicts mean effects, both for trabecular and cortical bones, of design factors.

I- I trabecular bone (mm 3) ST 5.03E-02 4.31E-02 2.82E+00 4.65E-02 1.95E-02 1.90E-02 2.16E+00 1.46E-02 4.71E-02 3.43E-02 5.07E-02 2.20E+00 3.39E+00 6.19E-03 2.24E+00 1.45E-01

I- I cortical bone (mm 3) ST 8.01E-02 1.02E-01 1.95E-03 3.23E-02 5.47E-02 8.34E-02 6.59E-02 3.35E-02 8.72E-02 8.34E-02 7.31E-02 7.99E-02 7.62E-02 7.09E-02 8.60E-02 5.65E-02

0.10 10.00 10.00 0.15 20.00 20.00 0.20 30.00 30.00 0.10 20.00 30.00 0.05 30.00 20.00 0.20 5.00 10.00 5.00 5.00 20.00 30.00 5.00 0.15 10.00 0.20 20.00 0.10 0.15 5.00 5.00

0.15 30.00 10.00 0.05 10.00 30.00 0.20 10.00 20.00 0.10 30.00

0.05 20.00 10.00

Tab. 5 Fractional array L16 and implant stability indexes

2,00
I-ST - trabecular bone (mm3)

0,09
I-ST - cortical bone (mm3)

1,60 1,20 0,80 0,40 0,00

0,08

0,07

0,06

0,05

a - stability index for trabecular bone

b - stability index for cortical bone

Fig. 4 Mean effects of stability indexes for trabecular and cortical bones (main factors)

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Studying the influence of thread features in osseo-integrated implants

Contribution Index (%) - trabecular bone

40%

Contribution Index (%) - cortical bone

p w t Factor 1 2

30%

30%

20%

20%

10%

10%

0%

0%
p w t Factor 1 2

a - contribution indexes for trabecular bone Fig. 5 Contribution indexes

b - contribution indexes for cortical bone

a - cumulative contribution indexes for trabecular bone

b - cumulative contribution indexes for cortical bone

Fig. 6 Cumulative contribution indexes

By statistically analyzing data through a Pareto ANOVA [12], contribution indexes were calculated. For instance, contribution index quantifies the influence of each design factor with respect to the implant stability index. Highest contribution indexes correspond to the most significant design factors. Figs. 5 and 6 depict contribution indexes and their cumulative values, respectively.

Future improvements of this research will focus on a two-factor and higher interactions in order to deeper understand how much load is transferred from the implant to the bone tissue and what may be the optimal implant design.

References
[1] S.H. Chung, S.J. Heo, J.Y. Koak, S.K. Kim, J.B. Lee, J.S. Han, C.H. Han, I.C. Rhyu, S.J. Lee. Effects of implant geometry and surface treatment on osseointegration after functional loading: a dog study. Journal of Oral Rehabilitation, 35 (2008), pp. 229236. [2] J.P. Geng, D.W. Xu, K.B. Tan, G.R. Liu. Finite element analysis of an osseointegrated stepped screw dental implant. Journal of Oral Implantology, 30 (2004), pp. 223233. [3] P. Branemark, B. Hansson, R. Adell. Osseointegrated Implants in the Treatment of the Edentulous Jaw, Experience from a 10-year period. J Plast Reconstr Surg Suppl, 16, 1 (1977), pp.132-136. [4] H. Abuhussein, G. Pagni, A. Rebaudi, H.L. Wang. The effect of thread pattern upon implant osseointegration. Clinical oral implant research, 21, (2010), pp. 129136. [5] H.J. Chun, S.Y. Cheong, J.H. Han, S.J. Heo, J.P. Chung, I.C. Rhyu, Y.C. Choi, H.K. Baik, Y. Ku, M.H. Kim. Evaluation of design parameters of osseointegrated dental implants using finite element analysis. Journal of Oral Rehabilitation, 29 (2002), pp. 565574. [6] P. Ma, H.C. Liu, D.H. Li, S. Lin, Z. Shi, Q.J. Peng. Influence of helix angle and density on primary stability of immediately loaded dental implants: Three-dimensional finite element analysis. Journal of stomatology, 42 (2007), pp. 618621. [7] L. Chia-Chin, L. Shang-Chih, K. Ming-Jen, W. ShuWei, F. Ping-Yuen. Effects of implant threads on the
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4 Discussion and conclusions

Assuming a significant value of 90%, variations of pitch and angle 1 do not influence implant stability, when looking at the trabecular bone. Instead, when considering the cortical bone, angles 1 and 2 may be neglected. Thread-width, w, seems to play a very significant role on implant stability: its contribution index becomes 29% and 31% with respect to trabecular and cortical bone, respectively. This finding says that variations of this design factor may strongly influence implant stability and, then, bone integrity. Same conclusions can be formulated when looking at the thread-tick, t. Very interesting is the analysis of the mean effects. Looking at fig. 4.b (cortical results) one should observe that mean effects of thread-width and -tick seems to be positively correlated each-other. In particular, when adopting the level "4", both for the w and t factors, the stability index becomes the maximum. Moreover, this result shows that interactions among factors may arise. However, the adopted factorial design does not allows to account such a phenomena, due to aliasing effects among factors. Apart from the limitations and the simplifications of the present research, findings showed the following key issues: thread-width and -tick play a significant role in implant stability; and, design factors may be correlated each-other.
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Studying the influence of thread features in osseo-integrated implants

contact area and stress distribution of marginal bone, J Dent Sci, 5, 3 (2010), pp. 156165. [8] L. Baggi, I. Cappelloni, M. Di Girolamo, F. Maceri, G. Vairo. The influence of implant diameter and length on stress distribution of osseointegrated implants related to crestal bone geometry: A three dimensional finite element analysis. J Prosthet Dent, 100 (2008), pp. 422-431. [9] I.P. Geng, K.B. Tan, G.R. Liu. Application of finite element analysis in implant dentistry: a review of the literature. J Prosthet Dent, 85 (2001), pp. 585-98. [10] P. Franciosa, M. Martorelli, G. Marenzi, G. Sammartino. Stress Distribution on the Bone Tissue: a Preliminary Comparative Study of Different Fixture

Designs, Proc. of the Int. Conference IDMME, Bordeaux (France), October, 20-22, ISBN: 978-2-8178-0168-1, 2010. [11] D. Bozkaya, S. Muftu, A. Muftu. Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite elements analysis. J of prosthetic dentistry, 523, (2004), pp. 524530. [12] D. C. Montgomery. Design and Analysis of Experiments. Wiley, Inc. 2001. [13] R.B. Martin, D.B. Burr, N.A. Sharkey. Skeletal tissue mechanics. New York, Springer 1998. pp. 127-78.

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