Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
 
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 5874
 


 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 2  |  Page : 243-247  

Finite element evaluation to compare stress pattern in bone surrounding implant with carbon fiber-reinforced poly-ether-ether-ketone and commercially pure titanium implants


1 Department of Prosthodontics, Sharavathi Dental College and Hospital, Shivamoga, Karnataka, India
2 Department of Prosthodontics, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India

Date of Submission10-Apr-2021
Date of Acceptance01-Jul-2021
Date of Web Publication15-Jul-2022

Correspondence Address:
Dr. Syeda Amtul Haseeb
Department of Prosthodontics, Sharavathi Dental College and Hospital, Alkola, T H Road, Shivamoga - 577 205, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.njms_354_21

Rights and Permissions
   Abstract 


Background: Titanium allergy is a main reason for failure of dental implant. Hence, newer implant biomaterials have emerged such as zirconia and carbon or glass fiber reinforced poly-ether-ether-ketone (CFR-PEEK)-based materials. The aim of the present study was to compare the stress pattern in bone surrounding implant with CFR-PEEK and commercially pure titanium implant.
Materials and Methods: Three-dimensional formal model of mandibular first molar partsubstituting with implant supported crown was generated. Implant with dimensions of 10 mm length and 4.3 mm diameter was used in this study. Finite element models of CFR-PEEK and commercially pure titanium implant assemblies were generated. A 100 Newton (N) force was implemented along the long axis and obliquely at 30° to the long axis of implant. Von Mises pressures generated in the bone surrounding implant were analyzed using ANSYS workbench 16.0 and other finite element software.
Results: Similar stress distribution was detected in bone surrounding implant with CFR-PEEK implant and commercially pure titanium implant assembly under 100 N force applied vertically and obliquely.
Conclusion: PEEK reinforced with carbon or glass fiber implants can be a viable alternative in individuals who are more of esthetic concern and who demonstrate allergy to metallic implants.

Keywords: Carbon fiber reinforced poly-ether-ether-ketone implant, finite element analysis, stress distribution, titanium implant


How to cite this article:
Haseeb SA, Vinaya KC, Vijaykumar N, Sree Durga B A, Kumar AS, Sruthi MK. Finite element evaluation to compare stress pattern in bone surrounding implant with carbon fiber-reinforced poly-ether-ether-ketone and commercially pure titanium implants. Natl J Maxillofac Surg 2022;13:243-7

How to cite this URL:
Haseeb SA, Vinaya KC, Vijaykumar N, Sree Durga B A, Kumar AS, Sruthi MK. Finite element evaluation to compare stress pattern in bone surrounding implant with carbon fiber-reinforced poly-ether-ether-ketone and commercially pure titanium implants. Natl J Maxillofac Surg [serial online] 2022 [cited 2022 Aug 10];13:243-7. Available from: https://www.njms.in/text.asp?2022/13/2/243/350943




   Introduction Top


Implant-supported prosthesis used to replace missing teeth is the most accepted treatment option in prosthodontics nowadays. There is a continuous research going on to come out with new materials which can be used as implant biomaterials. From the decades, in dental and medical area, titanium is the gold standard material for endosseous implant because of its superior properties.[1]

Although titanium possesses superior properties, few disadvantages of this material such as potential hypersensitivity in susceptible individuals and its darker color which causes dark appearance of the peri-implant mucosa, which has led to search for new implant biomaterials. In general, no material can be considered completely biocompatible. According to the literature, titanium allergy is a main reason for failure of dental implant.[1],[2],[3]

To overwhelm these limitations and to fulfil the esthetic demands, newer implant biomaterials have emerged in the field of implantology. These novel biomaterials consist of zirconia a high strength ceramic and poly-ether-ether-ketone (PEEK). Zirconia seems to be suitable implant biomaterial due its esthetic appearance, biocompatibility, and superb mechanical properties. According to the literature, zirconia has demonstrated successful osseointegration and stress distribution similar to titanium implants.[4],[5],[6],[7]

PEEK is a high temperature thermoplastic polymer, composed of ketone and ether functional groups. Chemical structure of PEEK has stability at high temperatures (exceeding 300°C). PEEK shows resistance to chemical and radiation damage. It can be strengthened with many reinforcing agents such as glass and carbon fibers. Pure PEEK has less modulus of elasticity of 3–4 GPa which is not sufficient to use as dental implant. It can be strengthened with many reinforcing agents such as glass and carbon fibers to increase modulus of elasticity. Surface modification with many materials such as TiO2 and tricalcium phosphate has resukted in successful osseoin similar to titanium implants. By 1990s, PEEK became popular high-performance polymer for replacing metallic implant in orthopedics. In 1992, PEEK was used in dentistry, first as esthetic abutments and later as implant. PEEK implant has unique characteristics, including biocompatibility, radiolucency on X-ray, magnetic resonance imaging compatibility, adjustable mechanical performance, chemical resistance, and sterilization capability.[8]

A main reason for the failure or success of a dental implant is the manner in which stresses are transmitted to peri-implant bone. Several studies have identified the pattern of stresses in bone-implant interface as well as in cortical bone and trabacular bone with finite element analysis (FEA).[9] FEA is a commonly followed method to determine the biomechanical effects of dental implants. The literature reveals that it has been widely used to model the design and functionality of dental implants. Direction, magnitude, and duration of load on the implant is significant in dissipation of forces from implant assembly into the surrounding bone.[10] Forces during mastication have a cyclic impact on alveolar bone and are applied during a limited period of mastication. Fatigue testing is considered most reliable test to obtain long-term data of clinical importance in the implant dentistry.[11],[12] In this study, stresses generated in bone surrounding implant with carbon fiber-reinforced PEEK (CFR-PEEK) and titanium implant assemblies were observed and compared.


   Materials and Methods Top


This study was carried out at MIT, Manipal. Methodology consists of geometric modeling and converting it into a mesh model. After obtaining mesh model, material properties were assigned. Boundary condition was determined and load at different angulations was applied. Analysis of stresses and comparison von Mises stresses was done. For ethical clearance was obtained from Sharavathi Dental College and Shivamogga, Institutional Ethical Committee with Ref No. SDC/SMG/2016/246.

Three-dimensional (3D) model of mandibular first molar area with implant-supported crown was created using Tata Technologies Certified Catia V5 R20. Bone section comprising cortical and cancellous bone with 28 mm height and 12 mm width corresponding to tooth number 36 was taken for the study. The bone quality D2 corresponding to the posterior mandible was generated. Design and dimensions of implant were considered according to Nobel Biocare implant system.[13] Dimensions for crown morphology were taken from the standard dental anatomy textbook.[14]

A graphic processing software ANSYS version 16.0, Ansys, Inc.Canonsburg, Pennsylvania, USA was used for creating 3D geometric mesh configuration of section of mandible with implant assembly using 115,250 nodes and 8,045,230 elements, as shown in [Figure 1].
Figure 1: FEM of D2 bone with implant assembly

Click here to view


Two different finite element models of CFR-PEEK and titanium implant assemblies were studied to compare the stresses in peri-implant bone. Both the models were similar, except for the material properties. All materials used in the models in this FEA study were considered as homogenous, isotropic, and linear elastic. Poisson's ratio and young's modulus of elasticity of materials were incorporated in the models to conduct FEA according to [Table 1]. A masticatory load of 100 Newton (N) at vertical and oblique at 30° to the long axis of implant were applied on to the occlusal surface of FEA model. Rigid supports were added in the lower and lateral regions of bone to simulate the bonding of the model to the rest of the jaw. Stress analysis was performed, and Von-Mises stresses were compared.
Table 1: Properties of materials used in the study

Click here to view



   Results Top


Amount of peak stresses in bone with both implants under vertical and oblique load are shown in [Table 2].
Table 2: Values of stresses in the bone with carbon or glass fiber reinforced poly-ether-ether-ketone and titanium implant assemblies under vertical and oblique load

Click here to view


Stress pattern with carbon fiber-reinforced poly-ether-ether-ketone implant with vertical and oblique load

Under vertical load, maximum stress of 2.1841 MPa around the apex of implant was observed. A lowest stress of 0.009065 Mpa was observed. Under oblique load, a maximum stress of 5.0280 Mpa around the neck of the implant was observed. A lowest stress value of 0.0064726 Mpa was observed. Stresses were distributed homogeneously over peri-implant bone [Figure 2].
Figure 2: Stress pattern with carbon fiber reinforced poly-ether-ether-ketone implant with vertical and oblique load

Click here to view


Stress pattern with titanium implant with vertical and oblique load

Under vertical load, maximum stress value of 2.1845 MPa just below the neck of the implant was observed, and minimum stress of 0.009024MPa was observed. Under oblique load, a maximum stress value around the neck of the implant observed was 5.1861 Mpa and minimum stress was 0.0064702 Mpa [Figure 3].
Figure 3: Stress pattern with titanium implant with vertical and oblique load

Click here to view


It was observed that, the stresses generated by CFR-PEEK and titanium implant assemblies were similar under vertical and oblique load, and stresses were homogenously distributed in peri implant bone.


   Discussion Top


Restoration of missing teeth with implant-supported prosthesis is the most recommended option in edentulous patients. Superior properties and biocompatibility of zirconia and CFR-PEEK could replace titanium in individuals who are allergic to titanium as literature shows titanium allergy is one of the important cause for implant failure. Studies have proved that PEEK reinforced with carbon or glass fibers is biocompatible and possess excellent properties and distributes stress similar to titanium.[8],[11],[15],[16],[17],[18]

PEEK is a thermoplastic polymer and well-known alternative biomaterial to metallic implants in orthopedics and traumatology. Pure PEEK possesses modulus of elasticity of 3–4 Gpa which shows higher deformation. According to the literature, PEEK reinforced with glass and carbon fibers, PEEK with surface modifications has shown osseointegration and stress distribution similar to titanium.[19] Lee et al. and Schwitalla et al. with their studies demonstrated that PEEK reinforced with glass and carbon fibers is suitable as dental implant biomaterial.[11],[15],[20] In contrast to the current study, in a study by Sarot et al.,[21] 30% CFR-PEEK and titanium was used to compare the stress pattern around implant bone. They determined that under oblique load, CFR-PEEK implant indicated greater stresses at the bone-implant contact because of a greater deformation of PEEK implant than titanium implant.

It was suggested that further strongly reinforced PEEK implant could reduce stresses at bone-implant contact due to the increased modulus of elasticity. Hence, accordingly, PEEK implant reinforced with 60% carbon fibers was considered in the study. According to a literature tapered or screw-shaped implants are of better choice than cylindrical implants.[22]

In the current study, 100 N load was applied in vertical and oblique at 30° direction and stress pattern in the surrounding bone was assessed. 100 N load was used in accordance to previous studies where 100 N vertical and oblique load was applied on occlusal surface, which aims to simulate real function situation of the oral cavity.[20],[23],[24] It was detected that with vertical load both implant assemblies demonstrated similar stress pattern. Under oblique load, titanium implant assembly has caused slightly more stress compared to and CFR-PEEK implant assembly. Under oblique load, results are similar to studies which has shown that tapered endosseous implant with high modulus of elasticity would be more suitable for implant dentistry.[20],[22] Modulus of elasticity and load transfer is an important criterion for the selection of dental implant to achieve homogeneous stress distribution in peri-implant bone.

This FEA study has demonstrated the importance of CFR-PEEK implants which has demonstrated similar von Mises stresses as titanium implant. Hence, CFR-PEEK can be viable alternatives for Titanium, especially for those who show titanium allergy and esthetic concern.

The present study is a computational method of testing the 3D models by crating real oral function. However, further long-term clinical trials are required for evaluating clinical success on long-term basis.


   Conclusion Top


Importance of implant biomaterials other than titanium such as CFR-PEEK should be considered. In this study, stress generated by CFR-PEEK implant is compared with titanium. Similar stresses in peri implant bone were observed with both CFR-PEEK and titanium implant biomaterials. Hence, CFR-PEEK implants can be considered an alternative to titanium implants in patients with metallic allergies and also as an esthetic implant biomaterial.

Acknowledgment

We are thankful to the faculty of MIT, Manipal, for helping in carryout this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Egusa H, Ko N, Shimazu T, Yatani H. Suspected association of an allergic reaction with titanium dental implants: A clinical report. J Prosthet Dent 2008;100:344-7.  Back to cited text no. 1
    
2.
Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E, et al. Titanium allergy in dental implant patients: A clinical study on 1500 consecutive patients. Clin Oral Implants Res 2008;19:823-35.  Back to cited text no. 2
    
3.
Haseeb SA, Kamath GP, Naveen YG, Vinaya KC, Rajput V, Titanium allergy – A less explored area in dentistry. J Appl Dent Med Sci 2019;19:523-32.  Back to cited text no. 3
    
4.
Koch FP, Weng D, Kramer S, Biesterfeld S, Jahn-Eimermacher A, Wagner W. Osseointegration of one-piece zirconia implants compared with a titanium implant of identical design: A histomorphometric study in the dog. Clin Oral Implants Res 2010;21:350-6.  Back to cited text no. 4
    
5.
Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials 1999;20:1-25.  Back to cited text no. 5
    
6.
Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, et al. Osseointegration of zirconia implants compared with titanium: An in vivo study. Head Face Med 2008;4:30.  Back to cited text no. 6
    
7.
Depprich R, Zipprich H, Ommerborn M, Mahn E, Lammers L, Handschel J, et al. Osseointegration of zirconia implants: An SEM observation of the bone-implant interface. Head Face Med 2008;4:25.  Back to cited text no. 7
    
8.
Williams DF, McNamara A, Turner RM. Potential of polyetheretherketone (PEEK) and carbon-fiber reinforced PEEK in medical applications. J Mat Sci Letters 1987;6:199-90.  Back to cited text no. 8
    
9.
Geng JP, Xu W, Tan KB, Liu GR, Finite element analysis of an osseointegrated stepped screw dental implant. J Oral Implantol 2004;30:223-33.  Back to cited text no. 9
    
10.
Moeen F, Nisar S, Dar N. A step by step guide to finite element analysis in dental implantology. Pak Oral Dent J 2014;34:164-9.  Back to cited text no. 10
    
11.
Lee WT, Koak JY, Lim YJ, Kim SK, Kwon HB, Kim MJ. Stress shielding and fatigue limits of poly-ether-ether-ketone dental implants. J Biomed Mater Res B Appl Biomater 2012;100:1044-52.  Back to cited text no. 11
    
12.
Geng JP, Tan KB, Liu GR. Applications of finite element analysis in implant dentistry: A review of literatures. J Prosthet Dent 2001;85:585-98.  Back to cited text no. 12
    
13.
Li T, Hu K, Cheng L, Ding Y, Ding Y, Shao J, et al. Optimum selection of the dental implant diameter and length in the posterior mandible with poor bone quality – A 3D finite element analysis. Applied Mathematical Modelling 2011;35:446-56.  Back to cited text no. 13
    
14.
Ash MM, Nelson SJ. Wheeler's Dental Anatomy, Physiology and Occlusion. 8th ed. 2003. p. 302.  Back to cited text no. 14
    
15.
Schwitalla AD, Abou-Emara M, Spintig T, Lackmann J, Müller WD. Finite element analysis of the biomechanical effects of PEEK dental implants on the peri-implant bone. J Biomech 2015;48:1-7.  Back to cited text no. 15
    
16.
Chang CL, Chen CS, Yeung TC, Hsu ML. Biomechanical effect of a zirconia dental implant-crown system: A three-dimensional finite element analysis. Int J Oral Maxillofac Implants 2012;27:e49-57.  Back to cited text no. 16
    
17.
Gujjarlapudi MC, Nunna NV, Manne SD, Sarikonda VR, Madineni PK, Meruva RN. Predicting peri-implant stresses around titanium and zirconium dental implants – A finite element analysis. J Indian Prosthodont Soc 2013;13:196-204.  Back to cited text no. 17
    
18.
Bankoğlu Güng ör M, Yılmaz H. Evaluation of stress distributions occurring on zirconia and titanium implant-supported prostheses: A three-dimensional finite element analysis. J Prosthet Dent 2016;116:346-55.  Back to cited text no. 18
    
19.
Rahmitasari F, Ishida Y, Kurahashi K, Matsuda T, Watanabe M, Ichikawa T. PEEK with reinforced materials and modifications for dental implant applications. Dent J 2017;5:35.  Back to cited text no. 19
    
20.
Schwitalla AD, Spintig T, Kallage I, Müller WD. Pressure behavior of different PEEK materials for dental implants. J Mech Behav Biomed Mater 2016;54:295-304.  Back to cited text no. 20
    
21.
Sarot JR, Contar CM, Cruz AC, de Souza Magini R. Evaluation of the stress distribution in CFR-PEEK dental implants by the three-dimensional finite element method. J Mater Sci Mater Med 2010;21:2079-85.  Back to cited text no. 21
    
22.
Rieger MR, Fareed K, Adams WK, Tanquist RA. Bone stress distribution for thr three endosseous implants. J Prosthet Dent 1989;61:223-8.  Back to cited text no. 22
    
23.
Isidor F. Influence of forces on peri-implant bone. Clin Oral Implants Res 2006;17 Suppl 2:8-18.  Back to cited text no. 23
    
24.
Kitamura E, Stegaroiu R, Nomura S, Miyakawa O. Biomechanical aspects of marginal bone resorption around osseointegrated implants: Considerations based on a three-dimensional finite element analysis. Clin Oral Implants Res 2004;15:401-12.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed80    
    Printed0    
    Emailed0    
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal