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Research Papers

Remodeling of the Mandibular Bone Induced by Overdentures Supported by Different Numbers of Implants

[+] Author and Article Information
Kai Li

State Key Laboratory of Military Stomatology,
Department of Prosthodontics,
Stomatology School,
Fourth Military Medical University,
145 Changle Xi Road,
Xi'an 710032, China
e-mail: 54918808@qq.com

Haitao Xin

State Key Laboratory of Military Stomatology,
Department of Prosthodontics,
Stomatology School,
Fourth Military Medical University,
145 Changle Xi Road,
Xi'an 710032, China
e-mail: xhthmj@fmmu.edu.cn

Yanfang Zhao

State Key Laboratory of Military Stomatology,
Department of Prosthodontics,
Stomatology School,
Fourth Military Medical University,
145 Changle Xi Road,
Xi'an 710032, China
e-mail: 245561054@qq.com

Zhiyuan Zhang

State Key Laboratory of Military Stomatology,
Department of Prosthodontics,
Stomatology School,
Fourth Military Medical University,
145 Changle Xi Road,
Xi'an 710032, China
e-mail: 295095130@qq.com

Yulu Wu

State Key Laboratory of Military Stomatology,
Department of Prosthodontics,
Stomatology School,
Fourth Military Medical University,
145 Changle Xi Road,
Xi'an 710032, China
e-mail: 331617386@qq.com

1Corresponding author.

Manuscript received April 25, 2015; final manuscript received February 16, 2016; published online March 21, 2016. Assoc. Editor: Guy M. Genin.

J Biomech Eng 138(5), 051003 (Mar 21, 2016) (8 pages) Paper No: BIO-15-1197; doi: 10.1115/1.4032937 History: Received April 25, 2015; Revised February 16, 2016

The objective of this study was to investigate the process of mandibular bone remodeling induced by implant-supported overdentures. computed tomography (CT) images were collected from edentulous patients to reconstruct the geometry of the mandibular bone and overdentures supported by implants. Based on the theory of strain energy density (SED), bone remodeling models were established using the user material subroutine (UMAT) in abaqus. The stress distribution in the mandible and bone density change was investigated to determine the effect of implant number on the remodeling of the mandibular bone. The results indicated that the areas where high Mises stress values were observed were mainly situated around the implants. The stress was concentrated in the distal neck region of the distal-most implants. With an increased number of implants, the biting force applied on the dentures was almost all taken up by implants. The stress and bone density in peri-implant bone increased. When the stress reached the threshold of remodeling, the bone density began to decrease. In the posterior mandible area, the stress was well distributed but increased with decreased implant numbers. Changes in bone density were not observed in this area. The computational results were consistent with the clinical data. The results demonstrate that the risk of bone resorption around the distal-most implants increases with increased numbers of implants and that the occlusal force applied to overdentures should be adjusted to be distributed more in the distal areas of the mandible.

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Copyright © 2016 by ASME
Topics: Bone , Density
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References

Doundoulakis, J. H. , Eckert, S. E. , Lindquist, C. C. , and Jeffcoat, M. K. , 2003, “ The Implant-Supported Overdenture as an Alternative to the Complete Mandibular Denture,” J. Am. Dent. Assoc., 134(11), pp. 1455–1458. [CrossRef] [PubMed]
Redford, M. , Drury, T. F. , Kingman, A. , and Brown, L. J. , 1996, “ Denture Use and the Technical Quality of Dental Prostheses Among Persons 18–74 Years of Age: United States, 1988–1991,” J. Dent. Res., 75, pp. 714–725. [PubMed]
Burns, D. R. , 2000, “ Mandibular Implant Overdenture Treatment: Consensus and Controversy,” J. Prosthodontics, 9(1), pp. 37–46. [CrossRef]
Engquist, B. , Bergendal, T. , Kallus, T. , and Linden, U. , 1988, “ A Retrospective Multicenter Evaluation of Osseointegrated Implants Supporting Overdentures,” Int. J. Oral Maxillofac. Implants, 3(2), pp. 129–134. [PubMed]
Johns, R. B. , Jemt, T. , Heath, M. R. , Hutton, J. E. , McKenna, S. , McNamara, D. C. , van Steenberghe, D. , Taylor, R. , Watson, R. M. , and Herrmann, I. , 1992, “ A Multicenter Study of Overdentures Supported by Branemark Implants,” Int. J. Oral Maxillofac. Implants, 7(4), pp. 513–522. [PubMed]
Bergendal, T. , and Engquist, B. , 1998, “ Implant-Supported Overdentures: A Longitudinal Prospective Study,” Int. J. Oral Maxillofac. Implants, 13(2), pp. 253–262. [PubMed]
Mericske-Stern, R. , 1990, “ Clinical Evaluation of Overdenture Restorations Supported by Osseointegrated Titanium Implants: A Retrospective Study,” Int. J. Oral Maxillofac. Implants, 5(4), pp. 375–383. [PubMed]
Liu, J. , Pan, S. , Dong, J. , Mo, Z. , Fan, Y. , and Feng, H. , 2013, “ Influence of Implant Number on the Biomechanical Behaviour of Mandibular Implant-Retained/Supported Overdentures: A Three-Dimensional Finite Element Analysis,” J. Dent., 41(3), pp. 241–249. [CrossRef] [PubMed]
Heckmann, S. M. , Winter, W. , Meyer, M. , Weber, H. P. , and Wichmann, M. G. , 2001, “ Overdenture Attachment Selection and the Loading of Implant and Denture-Bearing Area. Part 2: A Methodical Study Using Five Types of Attachment,” Clin. Oral Implants Res., 12(6), pp. 640–647. [CrossRef] [PubMed]
Porter, J. A., Jr. , Petropoulos, V. C. , and Brunski, J. B. , 2002, “ Comparison of Load Distribution for Implant Overdenture Attachments,” Int. J. Oral Maxillofac. Implants, 17(5), pp. 651–662. [PubMed]
Mericske-Stern, R. D. , Taylor, T. D. , and Belser, U. , 2000, “ Management of the Edentulous Patient,” Clin. Oral Implants Res., 11(Suppl. 1), pp. 108–125. [CrossRef] [PubMed]
Kronstrom, M. , Davis, B. , Loney, R. , Gerrow, J. , and Hollender, L. , 2010, “ A Prospective Randomized Study on the Immediate Loading of Mandibular Overdentures Supported by One or Two Implants: A 12-Month Follow-Up Report,” Int. J. Oral Maxillofac. Implants, 25(1), pp. 181–188. [PubMed]
Liddelow, G. , and Henry, P. , 2010, “ The Immediately Loaded Single Implant-Retained Mandibular Overdenture: A 36-Month Prospective Study,” Int. J. Prosthodontics, 23(1), pp. 13–21.
Ben-Ur, Z. , Gorfil, C. , and Shifman, A. , 1996, “ Anterior Implant-Supported Overdentures,” Quintessence Int., 27(9), pp. 603–606. [PubMed]
Meijer, H. J. , Raghoebar, G. M. , Batenburg, R. H. , Visser, A. , and Vissink, A. , 2009, “ Mandibular Overdentures Supported by Two or Four Endosseous Implants: A 10-Year Clinical Trial,” Clin. Oral Implants Res., 20(7), pp. 722–728. [CrossRef] [PubMed]
Li, J. , Li, H. , Shi, L. , Fok, A. S. , Ucer, C. , Devlin, H. , Horner, K. , and Silikas, N. , 2007, “ A Mathematical Model for Simulating the Bone Remodeling Process Under Mechanical Stimulus,” Dent. Mater., 23(9), pp. 1073–1078. [CrossRef] [PubMed]
Lian, Z. , Guan, H. , Ivanovski, S. , Loo, Y. C. , Johnson, N. W. , and Zhang, H. , 2010, “ Effect of Bone to Implant Contact Percentage on Bone Remodelling Surrounding a Dental Implant,” Int. J. Oral Maxillofac. Surg., 39(7), pp. 690–698. [CrossRef] [PubMed]
Mellal, A. , Wiskott, H. W. , Botsis, J. , Scherrer, S. S. , and 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 Implants Res., 15(2), pp. 239–248. [CrossRef] [PubMed]
Kitamura, E. , Stegaroiu, R. , Nomura, S. , and Miyakawa, O. , 2004, “ Biomechanical Aspects of Marginal Bone Resorption Around Osseointegrated Implants: Considerations Based on a Three-Dimensional Finite Element Analysis,” Clin. Oral Implants Res., 15(4), pp. 401–412. [CrossRef] [PubMed]
Akca, K. , and Cehreli, M. C. , 2006, “ Biomechanical Consequences of Progressive Marginal Bone Loss around Oral Implants: A Finite Element Stress Analysis,” Med. Biol. Eng. Comput., 44(7), pp. 527–535. [CrossRef] [PubMed]
Baggi, L. , Cappelloni, I. , Di Girolamo, M. , Maceri, F. , and Vairo, G. , 2008, “ 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. Prosthetic Dent., 100(6), pp. 422–431. [CrossRef]
Boccaccio, A. , Kelly, D. J. , and Pappalettere, C. , 2012, “ A Model of Tissue Differentiation and Bone Remodelling in Fractured Vertebrae Treated With Minimally Invasive Percutaneous Fixation,” Med. Biol. Eng. Comput., 50(9), pp. 947–959. [CrossRef] [PubMed]
Koos, B. , Godt, A. , Schille, C. , and Göz, G. , 2010, “ Precision of an Instrumentation-Based Method of Analyzing Occlusion and Its Resulting Distribution of Forces in the Dental Arch,” J. Orofacial Orthop., 71(6), pp. 403–410. [CrossRef]
Van Oosterwyck, H. , Duyck, J. , Vander Sloten, J. , Van der Perre, G. , De Cooman, M. , Lievens, S. , Puers, R. , and Naert, I. , 1998, “ The Influence of Bone Mechanical Properties and Implant Fixation Upon Bone Loading Around Oral Implants,” Clin. Oral Implants Res., 9(6), pp. 407–418. [CrossRef] [PubMed]
Cattaneo, P. M. , Dalstra, M. , and Melsen, B. , 2005, “ The Finite Element Method: A Tool to Study Orthodontic Tooth Movement,” J. Dent. Res., 84(5), pp. 428–433. [CrossRef] [PubMed]
Daas, M. , Dubois, G. , Bonnet, A. S. , Lipinski, P. , and Rignon-Bret, C. , 2008, “ A Complete Finite Element Model of a Mandibular Implant-Retained Overdenture With Two Implants: Comparison Between Rigid and Resilient Attachment Configurations,” Med. Eng. Phys., 30(2), pp. 218–225. [CrossRef] [PubMed]
Geramy, A. , 2000, “ Alveolar Bone Resorption and the Center of Resistance Modification (3-D Analysis by Means of the Finite Element Method),” Am. J. Orthod. Dentofacial. Orthop., 117(4), pp. 399–405. [CrossRef] [PubMed]
Holmes, D. C. , Diaz-Arnold, A. M. , and Leary, J. M. , 1996, “ Influence of Post Dimension on Stress Distribution in Dentin,” J. Prosthetic Dent., 75(2), pp. 140–147. [CrossRef]
Helgason, B. , Perilli, E. , Schileo, E. , Taddei, F. , Brynjolfsson, S. , and Viceconti, M. , 2008, “ Mathematical Relationships Between Bone Density and Mechanical Properties: A Literature Review,” Clin. Biomech., 23(2), pp. 135–146. [CrossRef]
Holmes, D. C. , and Loftus, J. T. , 1997, “ Influence of Bone Quality on Stress Distribution for Endosseous Implants,” J. Oral Implantology, 23(3), pp. 104–111.
Brunski, J. B. , Puleo, D. A. , and Nanci, A. , 2000, “ Biomaterials and Biomechanics of Oral and Maxillofacial Implants: Current Status and Future Developments,” Int. J. Oral Maxillofac. Implants, 15(1), pp. 15–46. [PubMed]
Menicucci, G. , Lorenzetti, M. , Pera, P. , and Preti, G. , 1998, “ Mandibular Implant-Retained Overdenture: Finite Element Analysis of Two Anchorage Systems,” Int. J. Oral Maxillofac. Implants, 13(3), pp. 369–376. [PubMed]
Weinans, H. , Huiskes, R. , and Grootenboer, H. J. , 1992, “ The Behavior of Adaptive Bone-Remodeling Simulation Models,” J. Biomech., 25(12), pp. 1425–1441. [CrossRef] [PubMed]
Zhao, Y. , Wang, W. , Xin, H. , Zang, S. , Zhang, Z. , and Wu, Y. , 2013, “ The Remodeling of Alveolar Bone Supporting the Mandibular First Molar With Different Levels of Periodontal Attachment,” Med. Biol. Eng. Comput., 51(9), pp. 991–997. [CrossRef] [PubMed]
Rungsiyakull, C. , Rungsiyakull, P. , Li, Q. , Li, W. , and Swain, M. , 2011, “ Effects of Occlusal Inclination and Loading on Mandibular Bone Remodeling: A Finite Element Study,” Int. J. Oral Maxillofac. Implants, 26(3), pp. 527–537. [PubMed]
Chen, G. , Pettet, G. , Pearcy, M. , and McElwain, D. L. , 2007, “ Comparison of Two Numerical Approaches for Bone Remodelling,” Med. Eng. Phys., 29(1), pp. 134–139. [CrossRef] [PubMed]
Maeda, Y. , and Wood, W. W. , 1989, “ Finite Element Method Simulation of Bone Resorption Beneath a Complete Denture,” J. Dent. Res., 68(9), pp. 1370–1373. [CrossRef] [PubMed]
Davis, W. H. , Lam, P. S. , Marshall, M. W. , Dorchester, W. , Hochwald, D. A. , and Kaminishi, R. M. , 1999, “ Using Restorations Borne Totally by Anterior Implants to Preserve the Edentulous Mandible,” J. Am. Dent. Assoc., 130(8), pp. 1183–1189. [CrossRef] [PubMed]
Chen, J. , Ahmad, R. , Suenaga, H. , Li, W. , Swain, M. , and Li, Q. , 2015, “ A Comparative Study on Complete and Implant Retained Denture Treatments—A Biomechanics Perspective,” J. Biomech., 48(3), pp. 512–519. [CrossRef] [PubMed]
Topkaya, T. , and Solmaz, M. Y. , 2015, “ The Effect of Implant Number and Position on the Stress Behavior of Mandibular Implant Retained Overdentures: A Three-Dimensional Finite Element Analysis,” J. Biomech., 48(10), pp. 2102–2109. [CrossRef] [PubMed]

Figures

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Fig. 1

Pretreatment intraoral view

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Fig. 2

Pretreatment CT image

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Fig. 3

Three-dimensional FE models of mandibular overdentures supported by different numbers of implants. (a) Two-implant model: two implants at the position of the mandibular bilateral lateral incisors; (b) three-implant model: one implant in the mandibular midline and the other two implants at the position of the canines; and (c) four-implant model: two implants at the position of the mandibular bilateral incisor and two located at the bilateral mandibular first premolar.

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Fig. 4

The distribution of the occlusal force recorded by a T-Scan III digital occlusal system. (a) Recordings of two-implant supported overdentures and (b) recordings of four-implant supported overdentures.

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Fig. 10

Clinical X-ray data from implant-supported overdenture restoration. (a) X-ray image of an implant in the left side of the mandibular bone from a patient with a two-implant supported overdenture in the 12th month; (b) X-ray image of an implant in the left side of the mandibular bone from a patient with a two-implant supported overdenture in the 24th month; (c) X-ray image of an implant in the left side of the mandibular bone from a patient with a four-implant supported overdenture in the 12th month; and (d) X-ray image of an implant in the left side of the mandibular bone from a patient with a four-implant supported overdenture in the 24th month.

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Fig. 9

Post-treatment intraoral view: (a) two implants and (b) four implants

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Fig. 8

Bone remodeling process for the three models

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Fig. 7

Density contours of the mandibular bone in the 24th month. (a) Density contour of cortical bone for the two-implant model; (b) density contour of cortical bone for the three-implant model; (c) density contour of cortical bone for the four-implant model; (d) density contour of cancellous bone for the two-implant model; (e) density contour of cancellous bone for the three-implant model; and (f) density contour of cancellous bone for the four-implant model.

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Fig. 6

Stress contours of the mandibular bone in the 24th month. (a) Stress contour of cortical bone for the two-implant model; (b) stress contour of cortical bone for the three-implant model; (c) stress contour of cortical bone for the four-implant model; (d) stress contour of cancellous bone for the two-implant model; (e) stress contour of cancellous bone for the three-implant model; and (f) stress contour of cancellous bone for the four-implant model.

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Fig. 5

Flowchart of the remodeling program

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