2015 Sho Kayumi
2015 Sho Kayumi
Abstract
Background: The purpose of this study was to investigate the influence of occlusal forces (the contractile force of
masticatory muscles) exerted during occlusal adjustment on the distribution of the forces among teeth, implants,
and temporomandibular joints (TMJs) in intercuspal clenching in cases with bilateral missing molars and premolars
by using finite element analysis.
Methods: A three-dimensional finite element model of the mandible with eight implants in the premolar and
molar regions was constructed. Linearly elastic material properties were defined for all elements except the
periodontal ligament, which was defined as nonlinearly elastic. The TMJs and antagonists were simplified and
replaced with nonlinear springs. Antagonists were assumed to be natural teeth or implants and had two- or
three-stage displaceability. We constructed finite element (FE) models in which occlusal adjustment with three
kinds of occlusal force (40 N as a light bite, 200 N as a hard bite, and 400 N as a maximum biting force) was
performed. The clearance by occlusal adjustment was decided beforehand with a trial-and-error method so that
the occlusal forces were distributed similarly to the distribution of the natural dentition. Each model was evaluated
under loads of 40, 100, 200, 400, and 800 N to determine the distribution of occlusal forces on the teeth and implants.
Results: The occlusal forces were concentrated on the most posterior implants while the load was larger, and the
percentage of bearing force at the TMJ was small, and vice versa.
Conclusions: Maximum biting force was better for occlusal adjustment to prevent overloading of the most posterior
implant.
Keywords: Implants; Occlusal adjustment; Nonlinear finite element analysis
© 2015 Kayumi et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly credited.
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 2 of 10
consider the far lower displaceability of implants than that sphere. The FE model consisted of approximately 42,000
of temporomandibular joints (TMJs) in the stomatog- nodes and 210,000 tetrahedral elements.
nathic system. The properties of the materials, except for the PDL,
The purpose of this study was, therefore, to investigate were based on previous studies [11–15] (Table 1). The
the influence of occlusal forces (the contractile force of biphasic properties for the PDL were determined accord-
masticatory muscles) exerted during occlusal adjustment ing to the literature [2, 3, 16, 17]. The PDL was assigned
on the distribution of forces among teeth, implants, and two-phase properties. Young’s modulus and Poisson’s ratio
TMJs during intercuspal clenching in cases with bilateral were 0.33 MPa and 0.3 for phase 1, respectively. For phase
missing molars and premolars by using finite element 2, they were 16 MPa and 0.45, respectively. Phase 2 was
analysis. applied when the von Mises stress exceeded 0.025 MPa.
The load-displacement curve of the teeth was verified with
Methods the analysis described below (Fig. 2a).
Finite element model
Three-dimensional finite element (FE) models were Boundary conditions of the model and simulation of
based on those reported by Kasai et al. [5] and consisted occlusal adjustment
of a mandible, natural teeth with periodontal ligaments, The boundary conditions used to verify the displaceabil-
and titanium implants with superstructures. All elements ity of teeth and analyze the distribution of occlusal
were homogenous and isotropic. In the models, eight im- forces are shown in Fig. 2a, b, respectively. In the former
plants replaced all of the premolars and molars (Fig. 1). model, a vertical load was applied to the left canine with
The mass/volume and the shape of the mandible were the restriction of nodes on the bottom of the mandible
assumed to be 2 and B, respectively, according to the clas- (Fig. 2a). FE analysis was performed under various loads
sification of Lekholm and Zarb [6]. The implant fixtures following the construction of a load-displacement curve.
were 3.75 mm in diameter and 10 mm in length [7]. The In the FE models used to analyze the distribution of
dimensions of the natural teeth and periodontal ligaments occlusal force, TMJs, maxillary teeth, and maxillary im-
were based on the literature [8–10]. The surface area of plants were replaced with appropriate springs to simplify
the periodontal ligament (PDL) corresponded to the ana- the model (Fig. 2b).
tomical value [10], and its thickness was 0.25 mm at all The antagonists of the mandibular anterior teeth were
sites. The occlusal surfaces of the implants and the teeth assumed to be natural teeth, and those of mandibular
were simplified and flattened in agreement with Monson’s implants were assumed to be either teeth or implants.
Fig. 1 Finite element models (model-I and model-T). The tooth roots and the implant bodies are displayed with permeability
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 3 of 10
Fig. 2 Boundary conditions to verify the displaceability of teeth (a) and analyze the distribution of occlusal forces (b). Arrows: loads, triangles:
restricted nodes, zigzags: springs
occlusal force was concentrated at the molar site im- 17.9 % of the occlusal force was distributed at the pre-
plants. In contrast, little or no occlusal force occurred at molar site implants under Load40N and Load100N,
the premolar site implants. The POF in the TMJ was respectively. The POF in the TMJ was 16.1 and 17.0 %
12.1 % under Load400N and 11.7 % under Load800N. under Load40N and Load100N, respectively. Under
Adj400N resulted in the reduction of POF at the molar Load200N, 20.3 % of the occlusal force was distributed
site implants to half of the POF in model-N under at the molar site implants and 14.0 % of the occlusal
Load40N and Load100N. On the other hand, 19.1 and force was distributed at the premolar site implants. The
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 5 of 10
Discussion
FE models
The FE models in this study were based on those re-
ported by Kasai et al. [5]. The material properties of the
soft tissues such as the PDL and the TMJ, which were
mainly deformed in the analysis, were considered to be
crucial, because the aim of this study was to investigate
the distribution of occlusal forces on the teeth, implants,
and TMJs. In Figs. 3 and 8, the PDLs of anterior teeth and
the springs corresponding to opposing teeth show two-
stage displaceability as reported previously [16, 17] and
were considered to be appropriate. The load-displacement
curve of the springs corresponding to TMJs was assumed
Fig. 3 Load-displacement curves of the springs
to be similar to that of the cartilage [18] because of its far
smaller elastic modulus than that of the TMJ disc [19, 20].
POF in the TMJ was larger than that in model-N. Under Therefore, the elastic modulus of the springs correspond-
Load800N, the POF at the molar site implants was ing to TMJs was determined based on the thicknesses of
36.3 %. However, almost no occlusal force occurred at the TMJ disc [21] and articular cartilage [19], the stress-
the premolar site implants and anterior teeth. The POF strain curve of the intervertebral discs [18], and the dis-
in the TMJ was almost the same as in model-N. placement of the condyle [22, 23] in intercuspal clenching
by indirect measurement. Although the material proper-
Model-I ties of human body depend on the individual, the models
The results of model-I are shown in Fig. 8. Adj40N re- in this study were therefore considered to be appropriate
sulted in the concentration of approximately 40 % of the to investigate the distribution of occlusal forces on the
occlusal force at the most posteriorly located implant on teeth, implants, and TMJs.
each side under all loading conditions. In other words,
about 80 % of the total occlusal force occurred at these The meaning of “occlusal adjustment” in this study
implants. However, the occlusal force scarcely occurred In the FE model before loading, there is no stress or
at the premolar site implants and natural teeth. Around deformation anywhere in the model with perfect even
10 % of the occlusal force was distributed at the TMJ. occlusal contact. However, this situation cannot really
The POF was smaller than that in model-N. occur because of the existence of some occlusal load in
Adj200N resulted in the concentration of the occlusal the intercuspal position (ICP). Since the displaceability of
force at the most anterior implant under Load40N and dental implants is quite different from that of the natural
Load100N. The POF in the anterior teeth and the TMJs teeth and TMJ, the distribution of the occlusal force
was larger than that in model-N under Load40N and exerted on the occlusal surface of natural teeth and super-
Load100N. Under Load400N, 38.0 % of the occlusal structures depends on the amount of the occlusal load,
force was concentrated at the molar site implants. Under i.e., the contractile force of the musculature. Thus, the
Load800N, 39.2 % of the occlusal force was concentrated “occlusal adjustment” performed on the FE models in this
at the molar site implants. Little occlusal force was present study was not a clinical procedure itself but a procedure
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 6 of 10
Fig. 4 Occlusal adjustment was simulated by altering the load-displacement curves of the springs
to set the models in the state of the ICP under various Loading conditions
occlusal loads. This problem can be clarified by the defin- In this study, we selected the loading conditions assum-
ition of the ICP itself. Although load and deformation of ing intercuspal clenching, because the effect of occlusal
the bone, joints, periodontal ligaments, and teeth in the adjustment was considered to appear clearly. Based on
ICP depend on the amount of the occlusal load, its defin- the literature [25, 26], occlusal loading of 200 N was
ition does not include how much occlusal load is appro- considered to correspond with a hard bite. The value for
priate to determine that a mandible is in the ICP [24]. The the “light bite” (40 N) was chosen so that the load in-
problem of occlusal adjustment of the superstructures on truded on all of the posterior teeth with a displacement
dental implants is, in a sense, deeply related to the defin- corresponding to the midpoint of the first phase in the
ition of the ICP. stress-displacement curve. This study was performed on
Fig. 5 Schematic diagram for each phase of the load-displacement curve after occlusal adjustment of implants. a: Before loading, only anterior
natural teeth were in contact with opposing teeth. Occlusal forces were not yet exerted anywhere. b: When a slight load caused the displacement
of the mandible upward by the distance corresponding to the gap, i.e., the quantity of occlusal adjustment, the anterior teeth displaced into the
socket and the implants were in contact with antagonists. Occlusal force was exerted only on anterior teeth. c: If the gaps were determined such
that occlusal adjustment was completed, occlusal forces were distributed among natural teeth and implants under certain amounts of load
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 7 of 10
Effect of occlusal loading in occlusal adjustment and Fig. 7 Load-displacement curve of the left canine
antagonists of implants
The occlusal force was concentrated on the most poster-
ior implants while the load was larger under all loading fulcrums of the rotation of the mandible. On the other
conditions. This concentration of the occlusal force hand, posterior implants were considered to be sepa-
could be explained by the displaceability of TMJs. Since rated from opposing teeth and implants when the load
it was far larger than that of the teeth and implants was less than that exerted during occlusal adjustment.
(Fig. 3), the TMJs and ramus of the mandible were dis- However, because of the smaller load itself, the actual
placed upward and the most posterior implants became occlusal force on the anterior implants was considered
Fig. 6 FE model with natural dentition (model-N). Tooth root is displayed with permeability
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 8 of 10
Fig. 8 Distribution of the occlusal forces. Left column: model-T, right column: model-I, “Natural dentition” indicates the results in model-N under
the load during occlusal adjustment
Kayumi et al. International Journal of Implant Dentistry (2015) 1:14 Page 9 of 10
while the load was less than that exerted during occlusal Author details
adjustment, and vice versa. However, when the percent- 1
Removable Prosthodontics, Hokkaido University Hospital, Hokkaido
age of bearing force at the TMJ was large, the absolute University, Kita-14, Nishi-5, Kita-Ku, Sapporo 060-8648, Japan. 2Department of
Oral Functional Prosthodontics, Division of Oral Functional Science, Graduate
force was not larger than in model-N under the load School of Dental Medicine, Hokkaido University, Kita-13, Nishi-7, Kita-Ku, Sapporo
during occlusal adjustment, because the load itself was 060-8648, Japan.
small. Therefore, the load borne by the TMJ was not
Received: 29 November 2014 Accepted: 20 May 2015
considered to be harmful in any case of occlusal adjust-
ment or load because the occlusal force itself was kept
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