RESEARCH AND EDUCATION

Three-dimensional finite element analysis of implant-assisted

removable partial dentures
Ju-Won Eom, DDS, MS,a Young-Jun Lim, DDS, MS, PhD,b Myung-Joo Kim, DDS, MS, PhD,c and
Ho-Beom Kwon, DDS, MS, PhDd

Various treatment options have ABSTRACT

been developed using dental Statement of problem. Whether the implant abutment in implant-assisted removable partial
implant systems, including dentures (IARPDs) functions as a natural removable partial denture (RPD) tooth abutment is
implant-retained overden- unknown.
tures, implant-supported
Purpose. The purpose of this 3-dimensional finite element study was to analyze the biomechanical
overdentures, and implant- behavior of implant crown, bone, RPD, and IARPD.
supported fixed prostheses.1,2
Recently implant-supported Material and methods. Finite element models of the partial maxilla, teeth, and prostheses were
generated on the basis of a patient’s computed tomographic data. The teeth, surveyed crowns, and
fixed restorations have been
RPDs were created in the model. With the generated components, four 3-dimensional finite
used in combination with element models of the partial maxilla were constructed: tooth-supported RPD (TB), implant-
removable partial dentures supported RPD (IB), tooth-tissue-supported RPD (TT), and implant-tissue-supported RPD (IT)
(RPDs) as an alternative treat- models. Oblique loading of 300 N was applied on the crowns and denture teeth. The von Mises
ment for patients with partial or stress and displacement of the denture abutment tooth and implant system were identified.
3
complete edentulism. The Results. The highest von Mises stress values of both IARPDs occurred on the implants, while those
benefits of implant-assisted of both natural tooth RPDs occurred on the frameworks of the RPDs. The highest von Mises stress of
RPDs have been described by model IT was about twice that of model IB, while the value of model TT was similar to that of model
several authors.3-7 An implant- TB. The maximum displacement was greater in models TB and TT than in models IB and IT. Among
assisted removable partial den- the 4 models, the highest maximum displacement value was observed in the model TT and the
lowest value was in the model IB.
ture (IARPD) is different from
an implant-retained RPD in Conclusions. Finite element analysis revealed that the stress distribution pattern of the IARPDs was
that the implant provides different from that of the natural tooth RPDs and the stress distribution of implant-supported RPD
an RPD abutment in an was different from that of implant-tissue-supported RPD. When implants are used for RPD
abutments, more consideration concerning the RPD design and the number or location of the
IARPD.7-10 The implant in an
implant is necessary. (J Prosthet Dent 2017;117:735-742)
IARPD provides retention and
support, which improves
masticatory efficiency and patient comfort and satisfac- IARPDs is also cost-effective as the number of implants is
tion.11 In addition, the implants protect the remaining reduced.15 Furthermore, by transforming Kennedy class I
natural teeth and preserve bone.12,13 Clasp arms can be RPDs to Kennedy class III through the placement of distal
replaced by retentive attachments to the implant abutment, implants, IARPDs can provide better support and increased
improving patients’ appearance.13,14 Treatment with masticatory force.16,17

Supported by grant 2015R1D1A1A01060940 from the National Research Foundation of Korea.

a
Graduate student, Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
b
Professor, Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
c
Associate Professor, Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
d
Associate Professor, Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea.

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736
Clinical Implications
When implants were used as abutments for the
removable partial denture (RPD) design, the highest
stress was concentrated on the implants in
implant-assisted removable partial dentures. To
avoid possible implant complications such as
prosthesis fracture, marginal bone loss, or implant
failure related to this stress concentration, it might
be necessary to consider the placement of multiple
implants, splinted prostheses, or the extension of
the RPD base to cover the maximum supporting
area.
Implant placement on the maxillary or mandibular
posterior regions is sometimes restricted by anatomic or
financial limitations. Some patients with complete
edentulism are unwilling to have extensive surgical pro-
cedures. In these situations, anterior implant-supported
fixed restorations in conjunction with RPDs can be an
effective treatment option.18 Chronopoulos et al3
described a patient with RPDs in which Kennedy class I
RPDs were used on the maxilla and mandible in combi-
nation with anterior fixed implant prostheses with semi-
precision attachments. The authors concluded that the use
of a dental implant as an abutment for a mandibular
extension RPD was an effective clinical solution.
Cunha et al19 demonstrated that the placement of a
dental implant diminished the tendency for intrusion of
RPDs. The authors constructed a 2-dimensional (2D)
finite element model of a partially edentulous mandible
and RPD models combined with an implant and
concluded that locating the implant near the abutment
tooth positively influenced the distribution of stresses on
the analyzed structures. Pellizzer et al20 studied the
association between a distal extension RPD and an
osseointegrated implant using 2D finite element analysis.
The authors reported that implants associated with a
healing abutment, Sterngold ERA overdenture attach-
ment (Sterngold), or a ball attachment exhibited favorable
stresses with an RPD. In contrast, distal extension RPDs
associated with a single implant-supported prosthesis in
the posterior area were not favorable. Shahmiri et al21
analyzed a Kennedy class I implant-assisted removable
prosthesis using finite element analysis. They constructed
a 3-dimensional (3D) human mandible model with an
RPD and an implant and analyzed the maximum defor-
mation and stress distribution of a framework and acrylic
resin in the RPD, cortical or cancellous bone, and implants.
The authors reported the deformation that might lead to
acrylic resin fracture in the prosthesis.
Finite element analysis has frequently been used in
dentistry to analyze the biomechanical behavior of
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 117 Issue 6
structures.22-27 It provides useful information that is
difficult to measure intraorally, including the results of
different component sizes and material changes, the
calculation of preload, the effect of implant-abutment
connections, and the influence of parafunctional
habits.22,24,25,28 Although several studies have described
the use of RPDs in conjunction with implant prostheses,
few studies have used 3D finite element analysis to
evaluate the use of implant prostheses as abutments for
RPDs.19,29,30 Therefore, the purpose of this 3D finite
element analysis study was to analyze the biomechanical
behavior of implant, bone, and RPD in different types of
IARPDs.
MATERIAL AND METHODS
Three-dimensional finite element models of an IARPD
and a tooth-supported RPD were constructed based on a
patient’s computed tomography (CT) image. Four 3D
finite element models of an implant-supported RPD (IB), a
tooth-supported RPD (TB), an implant-tissue-supported
RPD (IT), and a tooth-tissue-supported RPD (TT) were
constructed to simulate RPDs combined with implant
prostheses or natural teeth as abutments on the partially
edentulous maxilla. An oblique load of 300 N was applied
on the crowns and denture teeth. The maximum von
Mises stresses and the displacements of the denture
abutment teeth, implants, bone, and RPDs were identi-
fied. This study was approved by the institutional review
board of Seoul National University Dental Hospital.
The geometry of the maxilla was extracted from CT
data. The individual was healthy and had normal
craniofacial structures. The left side of the maxilla was
used to build a finite element model. The CT scans were
segmented using an image processing software (Amira;
FEI) and then exported into a meshing program (Visual-
Mesh; ESI Group), which produced the tetrahedral
volumetric meshes of the partial maxilla.
Four 3D finite element models representing half of
the maxilla, abutments, and half of the RPD were con-
structed. Two models had natural teeth, and the other 2
models had implant-supported surveyed crowns. The
model TB consisted of 2 surveyed crowns supported by
natural teeth in the area of the maxillary first premolar
and the second molar combined with the RPD. A
partially edentulous maxilla was created by removing the
second premolar and the first molar in the original model
and by replacing the first premolar and second molar
with the scan data of artificial teeth in the replica model
(Nissin D50-555; Nissin). The final model TB was
composed of palatal mucous membrane, cortical bone
and cancellous bone, periodontal ligaments, abutments,
surveyed crown, and RPD. The surveyed crowns had rest
seats and were modeled on the properties of a gold alloy.
The RPD had 2 Akers clasps.
Eom et al
June 2017 737

Figure 1. Structure of finite element models. A, Implant-supported RPD (IB). B, Tooth-supported RPD (TB). C, Implant-tissue-supported RPD (IT).
D, Tooth-tissue-supported RPD (TT). RPD, removable partial denture.

The model TT was created by removing the second Table 1. Finite element models
molar of the model TB and by covering edentulous area Removable
Partial No. of No. of
with denture base. Except for the difference in the second Model Abutment Denture Nodes Elements
molar region, all of the components of the model TT were TB Maxillary first premolar and maxillary Tooth 34 120 114 197
identical to those of the model TB. In the model IB, the second molar supported

natural tooth abutments of the model TB were replaced TT Maxillary first premolar Implant tissue 33 024 111 110
supported
with implants. In the model IT, the first premolar of the IB Implant-supported maxillary first Implant 39 902 140 223
model TT was replaced with an implant (Fig. 1). The premolar and implant-supported supported
maxillary second molar
models are summarized in Table 1.
IT Implant-supported maxillary first Implant tissue 36 048 124 373
The geometries of the dental implant system (Osstem premolar supported
US system; Osstem Implant Co) of all models were
provided by the manufacturer. The implant was 10 mm
long and 4 mm in diameter. The abutments and the Meshes of teeth, surveyed crowns, and RPDs were
abutment screws were designed independently and were created with 3D computer-aided design software (Visual-
assembled. The abutment screw was simplified and was Mesh; ESI Group) (Fig. 2). The meshes for the roots of the
in contact with the implant screw hole. The inferior teeth were surrounded by meshes of the periodontal liga-
surface of the abutment was in contact with the top of the ment that were 0.5 mm thick. The RPD model was composed
implant. The preload on the abutment screw was of a metal framework, acrylic resin base, and denture teeth.
generated to simulate screw tightening by using the bolt- The acrylic resin base was considered to be completely
pretension mechanism, which is included in the finite bonded with the denture tooth and metal framework.
element analysis software (ANSYS 14.5; Swanson Anal- All materials were assumed to be linearly elastic,
ysis Systems Inc).31 The preload used was 825 N.25 The homogenous, and isotropic to simplify the calculations.
implant was considered to be bonded with cancellous The elastic modulus and the Poisson ratio for each ma-
and cortical bone to simulate complete osseointegration. terial are summarized in Table 2.

Eom et al THE JOURNAL OF PROSTHETIC DENTISTRY

738 Volume 117 Issue 6

Figure 2. Coronal section of meshes. A, Coronal section of implant-supported removable partial denture (model IB). B, Coronal section of model TB.
C, Coronal section of model IT. D, Coronal section of model TT.

Finite element analysis was performed with software Table 2. Material properties of finite element models31,32
(ANSYS 14.5; Swanson Analysis Systems Inc). The inter- Material Elastic Modulus (GPa) Poisson Ratio
faces between the surveyed crowns and the clasps of the Titanium 110 0.33
RPDs were modeled as frictional contacts with appropriate Acrylic resin 2.2 0.31
friction coefficients (m=0.10).8 Contact analysis was also RPD framework (cobaltechromium) 211 0.3
applied to the interfaces between implant components. Tooth dentin 41 0.3

The coefficient of friction value between the abutment and Gold alloy 91 0.33
Periodontal ligament 3×10−5 0.45
implant was 0.16, and that between the abutment and
Cortical bone 13.7 0.3
abutment screw was 0.2.8 On the basis of previous studies,
Cancellous bone 1.37 0.33
oblique loading of 300 N was applied on the crown and
Mucosa 0.001 0.37
denture tooth to simulate masticatory loading.23,33 Oblique
RPD, removable partial denture.
force was directed at 14.04 degrees to the long axis of the
crown from the buccal to the lingual direction and
distributed to the central fossa and the lingual slopes of the Table 3. Highest von Mises stress values for each finite element model
Model IB TB IT TT
buccal cusps of all maxillary premolars and molars in the
Von Mises stress value (MPa) 120.6 279.7 252.5 307.4
models.34 All nodes of the most medial and most distal
surfaces in the models were constrained in all directions.
The von Mises stress value was used for the analysis, investigated. Maximum displacement of the finite element
appropriate for predicting failure of ductile materials such model was used to verify which compartments moved.
as titanium, cobalt-chromium, and gold alloy.24 Higher
RESULTS
von Mises stress values represent higher risk of fail-
ure.22,34,35 The von Mises stress values of the cortical bones, The highest von Mises stress values were observed on
cancellous bones, RPD frameworks, and implants in the different positions and compartments of each model
different types of IARPDs or natural tooth RPDs were (Table 3). The maximum von Mises stress values of the

THE JOURNAL OF PROSTHETIC DENTISTRY Eom et al

June 2017 739

Figure 3. Von Mises stress (GPa) of removable partial denture framework of finite element models. Red arrows indicate area of maximum von Mises
stress. A, Framework of model IB. B, Framework of model TB. C, Framework of model IT. D, Framework of model TT.

Table 4. Highest von Mises stress values (MPa) in each compartment

With regard to the IARPDs, the maximum von Mises
Model IB TB IT TT
stress values of the cancellous bone and cortical bone,
Cortical bone 33.5 6.5 61.4 6.1
RPD framework, and implant were about twice as high in
Cancellous bone 3.2 0.8 7.5 0.7
model IT as in model IB. For the tooth-supported RPDs,
RPD framework 72.7 279.7 163.1 307.4
Implant 120.6 - 252.4 -
the maximum von Mises stress values of the cortical bone
and cancellous bone were slightly higher in model TB
RPD, removable partial denture.
than those in model TT, while the maximum von Mises
stress value of the RPD framework was higher in model
Table 5. Highest maximum displacement value (mm) for each finite TT (307.4 MPa) than that in model TB (279.7 MPa)
element model (Table 4).
Model IB TB IT TT The maximum displacement values of each model are
Maximum displacement 0.05 1.05 0.36 1.08 summarized in Table 5. The maximum displacement of
models IT and TT occurred in the distal area of each RPD
(Fig. 4). The maximum displacement value that occurred
cancellous and cortical bone were higher in IARPDs (models
in the RPD framework of model TT was the highest
IB and IT) than in the tooth-supported RPDs (models TB and
among the models, while the maximum displace-
TT). However, the maximum von Mises stress values of the
ment value in the RPD framework of model IB was the
RPD framework were higher in the tooth-supported RPDs
lowest.
than in the IARPDs (Fig. 3). Both of the maximum stress
values of models TB (279.7 MPa) and TT (307.4 MPa)
DISCUSSION
occurred on the minor connector of the RPD, while both of
the maximum stress values of models IB (72.7 MPa) and IT The highest von Mises stress value in each IARPD model
(163.1 MPa) occurred on the distal side of the first thread of was located at the implant, and the implants were
the implant in the area of the first premolar in both models. assumed to bear most of the loading in models IB and IT.

Eom et al THE JOURNAL OF PROSTHETIC DENTISTRY

740
Figure 4. Maximum displacement of finite element models. Red arrows indicate area of maximum displacement. A, Maximum displacement of model
IB. B, Maximum displacement of model TB. C, Maximum displacement of model IT. D, Maximum displacement of model TT.
The highest von Mises stress of the implant was about
twice as great in model IT as in model IB, which might be
explained by the absence of the distal implant in model
IT. This result indicates that the tissue underlying the
RPD provided less support under loading than in model
IT and that the use of an implant affected the behavior of
the RPD. However, the models where implants were not
used showed different results. The highest von Mises
stress values in the models TB and TT were observed on
the RPD framework, and it was assumed that the RPD
framework, which had the highest elastic modulus,
experienced the greatest stress because the tooth abut-
ments were mobile because of the presence of the peri-
odontal ligament. These results are consistent with those
of a previous study in which the metal framework of a
mandibular RPD showed the highest strain patterns on
the major and minor connectors in a mandible model.21
Maximum displacement values varied for each model
depending on the presence or absence of the distal
implant. The maximum displacement value of model IT
was 7 times larger than that of model IB. The maximum
displacement values of the implant and the abutment of
the implant of model IB were no more than 25 mm, while
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 117 Issue 6
those of model IT were no more than 40 mm. These
values are within the normal range, which is about 10 to
50 mm as lateral force is loaded.36 It was assumed that as
the RPD in model IT moved downward to the tissue
under occlusal loading the tissue underneath the RPD
base resisted the occlusal loading.37 Thus, the IARPD in
model IT should have the maximum support-bearing
area underneath the base to distribute the total load
from the RPD abutment to the supporting tissue because
the stress around the implant and cortical bone was
found to be higher in model IT than in any other model
(Table 4). In addition, the use of multiple splinted im-
plants instead of a single implant as an RPD abutment
might decrease loading to the implants and thus reduce
the risk of complications.38
The reason that the implant models and natural tooth
models had different maximum displacement values was
that the abutment teeth of the natural tooth RPDs were
more displaceable than those of IARPDs because of the
periodontal ligament, which had a much lower elastic
modulus than any other component in the model. The
displacement of model TT was about three times as large
as that of model IT. The displacement of model TT was
Eom et al
June 2017
attributed to tooth-abutment mobility, the elasticity of
the RPD framework, and slipping of the RPD framework
from the surveyed crown. The displacement of model IT
was attributed to the elasticity of the RPD framework and
slipping of the RPD framework from the surveyed crown.
In this study, a preload of 825 N in the implant system
was created by using the bolt-pretension mechanism in
the ANSYS program.31 The 825-N preload was regarded
as the optimum preload, which was 75% of the yield
strength as recommended for the implant screwejoint
assembly.25 Lang et al25 reported that 75% of the yield
strength of the abutment screw was equal to using a
torque of 32 Ncm applied to the abutment screws in
implant assemblies with a coefficient friction of 0.12 be-
tween the implant components.
In the present study, several assumptions were made
to simplify the calculation. It was assumed that the
cortical and cancellous bones were isotropic, that the
mucosa was linearly elastic, and that all the interfaces
were bonded states except for the 2 frictional contact
interfaces between the surveyed crowns and the clasps of
the RPDs and between implant components. Some
components of the finite element models were simpli-
fied.22,28 In addition, only half of the maxilla and
the partial RPD were generated and used in the
present study. The contralateral side might have affected
the results. Further studies on RPD design, other
implanteabutment connection types, and the use of at-
tachments with more sophisticated models are required.
CONCLUSIONS
Within the limitation of this 3D finite element analysis,
the following conclusions were drawn:
1. The highest stress was concentrated on the implants
in both IARPDs.
2. Because the stress from the occlusal loading was
concentrated primarily on the implant when im-
plants were used for the RPD abutments, more
considerations concerning the RPD design and the
number or location of the implant are necessary.
REFERENCES
1. Mentag PJ, Kosinski TF, Sowinski LL. Fabrication of a maxillary prosthesis
using dental implants and an “overdenture” attachment. A clinical report.
J Prosthet Dent 1991;65:331-5.
2. Zitzmann NU, Marinello CP. Treatment plan for restoring the edentulous
maxilla with implant-supported restorations: removable overdenture versus
fixed partial denture design. J Prosthet Dent 1999;82:188-96.
3. Chronopoulos V, Sarafianou A, Kourtis S. The use of dental implants in
combination with removable partial dentures: a case report. J Esthet Restor
Dent 2008;20:355-64.
4. Sato M, Suzuki Y, Kurihara D, Shimpo H, Ohkubo C. Effect of implant
support on mandibular distal extension removable partial dentures: rela-
tionship between denture supporting area and stress distribution.
J Prosthodont Res 2013;572:109-12.
5. Jang Y, Emtiaz S, Tarnow DP. Single implant-supported crown used as an
abutment for a removable cast partial denture: a case report. Implant Dent
1998;7:199-204.
Eom et al
741
6. Mijiritsky E, Ormianer Z, Klinger A, Mardinger O. Use of dental implants to
improve unfavorable removable partial denture design. Compend Contin
Educ Dent 2005;26:744-6.
7. Yeung S, Chee WW, Torbati A. Design concepts of a removable partial dental
prosthesis with implant-supported abutments. J Prosthet Dent 2014;112:
99-103.
8. Shahmiri R, Das R, Aarts JM, Bennani V. Finite element analysis of an
implant-assisted removable partial denture during bilateral loading: occlusal
rests position. J Prosthet Dent 2014;112:1126-33.
9. Gharehchahi J, Asadzadeh N, Mirmortazavi A, Shakeri MT. Maximum dis-
lodging forces of mandibular implant-assisted removable partial dentures:
in vitro assessment. J Prosthodont 2013;22:543-9.
10. Wismeijer D, Tawse-Smith A, Payne AG. Multicentre prospective evaluation
of implant-assisted mandibular bilateral distal extension removable partial
dentures: patient satisfaction. Clin Oral Implants Res 2013;24:20-7.
11. Mijiritsky E. Implants in conjunction with removable partial dentures: a
literature review. Implant Dent 2007;16:146-54.
12. Werbitt MJ, Goldberg PV. The immediate implant: bone preservation and
bone regeneration. Int J Periodontics Restorative Dent 1992;12:206-17.
13. Keltjens HM, Kayser AF, Hertel R, Battistuzzi PG. Distal extension removable
partial dentures supported by implants and residual teeth: considerations and
case reports. Int J Oral Maxillofac Implants 1993;8:208-13.
14. Budtz-Jorgensen E, Bochet G, Grundman M, Borgis S. Aesthetic consider-
ations for the treatment of partially edentulous patients with removable
dentures. Pract Proced Aesthet Dent 2000;12:765-72.
15. de Carvalho WR, Barboza EP, Caula AL. Implant-retained removable pros-
thesis with ball attachments in partially edentulous maxilla. Implant Dent
2001;10:280-4.
16. Shahmiri RA, Atieh MA. Mandibular Kennedy Class I implant-tooth-borne
removable partial denture: a systematic review. J Oral Rehabil 2010;37:
225-34.
17. Ohkubo C, Kobayashi M, Suzuki Y, Hosoi T. Effect of implant support on
distal-extension removable partial dentures: in vivo assessment. Int J Oral
Maxillofac Implants 2008;23:1095-101.
18. Pellecchia M, Pellecchia R, Emtiaz S. Distal extension mandibular removable
partial denture connected to an anterior fixed implant-supported prosthesis:
a clinical report. J Prosthet Dent 2000;83:607-12.
19. Cunha LD, Pellizzer EP, Verri FR, Pereira JA. Evaluation of the influence of
location of osseointegrated implants associated with mandibular removable
partial dentures. Implant Dent 2008;17:278-87.
20. Pellizzer EP, Verri FR, Falcon-Antenucci RM, Goiato MC, Gennari Filho H.
Evaluation of different retention systems on a distal extension removable
partial denture associated with an osseointegrated implant. J Craniofac Surg
2010;21:727-34.
21. Shahmiri R, Aarts JM, Bennani V, Atieh MA, Swain MV. Finite element
analysis of an implant-assisted removable partial denture. J Prosthodont
2013;22:550-5.
22. Geng JP, Tan KB, Liu GR. Application of finite element analysis in
implant dentistry: a review of the literature. J Prosthet Dent 2001;85:
585-98.
23. Mericske-Stern R, Assal P, Mericske E, Burgin W. Occlusal force and oral
tactile sensibility measured in partially edentulous patients with ITI implants.
Int J Oral Maxillofac Implants 1995;10:345-53.
24. Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G. The influence of
implant diameter and length on stress distribution of osseointegrated im-
plants related to crestal bone geometry: a three-dimensional finite element
analysis. J Prosthet Dent 2008;100:422-31.
25. Lang LA, Kang B, Wang RF, Lang BR. Finite element analysis to determine
implant preload. J Prosthet Dent 2003;90:539-46.
26. Anitua E, Tapia R, Luzuriaga F, Orive G. Influence of implant length,
diameter, and geometry on stress distribution: a finite element analysis. Int J
Periodontics Restorative Dent 2010;30:89-95.
27. Murakami N, Wakabayashi N. Finite element contact analysis as a critical
technique in dental biomechanics: a review. J Prosthodont Res 2014;58:
92-101.
28. Torcato LB, Pellizzer EP, Verri FR, Falcón-Antenucci RM, Santiago Júnior JF,
de Faria Almeida DA. Influence of parafunctional loading and prosthetic
connection on stress distribution: a 3D finite element analysis. J Prosthet
Dent 2015;114:644-51.
29. Topkaya T, Solmaz MY. The effect of implant number and position on the
stress behavior of mandibular implant retained overdentures: a three-
dimensional finite element analysis. J Biomech 2015;48:2102-9.
30. Nakamura Y, Kanbara R, Ochiai KT, Tanaka Y. A finite element evaluation of
mechanical function for 3 distal extension partial dental prosthesis designs
with a 3-dimensional nonlinear method for modeling soft tissue. J Prosthet
Dent 2014;112:972-80.
31. Montgomery J. Methods for modeling bolts in the bolted joint. Paper pre-
sented at: ANSYS User’s Conference 2002. Available at: http://server2.docfoc.
com/uploads/Z2015/12/22/nLEFnyDdtB/3f012e1c82f1b6f7f034b0c2fcd09d06.
pdf. Accessed November 7, 2016.
32. Wang HY, Zhang YM, Yao D, Chen JH. Effects of rigid and nonrigid
extracoronal attachments on supporting tissues in extension base partial
THE JOURNAL OF PROSTHETIC DENTISTRY
742 Volume 117 Issue 6

removable dental prostheses: a nonlinear finite element study. J Prosthet 38. Sano M, Ikebe K, Yang TC, Maeda Y. Biomechanical rationale for six splinted
Dent 2011;105:338-46. implants in bilateral canine, premolar, and molar regions in an edentulous
33. O’Mahony AM, Williams JL, Spencer P. Anisotropic elasticity of cortical and maxilla. Implant Dent 2012;21:220-4.
cancellous bone in the posterior mandible increases peri-implant stress and
strain under oblique loading. Clin Oral Implants Res 2001;12:648-57.
34. Van Staden RC, Guan H, Loo YC. Application of the finite element method in Corresponding author:
dental implant research. Comput Methods Biomech Biomed Engin 2006;9:257-70. Dr Ho-Beom Kwon
35. Himmlova L, Dostalova T, Kacovsky A, Konvickova S. Influence of implant Dental Research Institute and Department of Prosthodontics
length and diameter on stress distribution: a finite element analysis. School of Dentistry
J Prosthet Dent 2004;91:20-5. Seoul National University
36. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant 101, Daehak-ro, Jongno-gu, Seoul 110-744
therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants REPUBLIC OF KOREA
Res 2005;16:26-35. Email: proskwon@snu.ac.kr
37. LaVere AM, Krol AJ. Selection of a major connector for the extension-base
removable partial denture. J Prosthet Dent 1973;30:102-5. Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.

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Grinding damage assessment for CAD-CAM restorative materials

Curran P, Cattani-Lorente M, Anselm Wiskott HW, Durual S, Scherrer SS

Dent Mater 2017;33:294-308
Objectives. To assess surface/subsurface damage after grinding with diamond discs on five CAD-CAM restorative
materials and to estimate potential losses in strength based on crack size measurements of the generated damage.
Methods. The materials tested were: Lithium disilicate (LIT) glass-ceramic (e.max CAD), leucite glass-ceramic (LEU)
(Empress CAD), feldspar ceramic (VM2) (Vita Mark II), feldspar ceramic-resin infiltrated (EN) (Enamic) and a
composite reinforced with nano ceramics (LU) (Lava Ultimate). Specimens were cut from CAD-CAM blocs and
pair-wise mirror polished for the bonded interface technique. Top surfaces were ground with diamond discs of
respectively 75, 54 and 18 mm. Chip damage was measured on the bonded interface using SEM. Fracture mechanics
relationships were used to estimate fracture stresses based on average and maximum chip depths assuming these to
represent strength limiting flaws subjected to tension and to calculate potential losses in strength compared to
manufacturer’s data.
Results. Grinding with a 75 mm diamond disc induced on a bonded interface critical chips averaging 100 mm with a
potential strength loss estimated between 33% and 54% for all three glass-ceramics (LIT, LEU, VM2). The softer
materials EN and LU were little damage susceptible with chips averaging respectively 26 mm and 17 mm with no loss in
strength. Grinding with 18 mm diamond discs was still quite detrimental for LIT with average chip sizes of 43 mm and a
potential strength loss of 42%.
Significance. It is essential to understand that when grinding glass-ceramics or feldspar ceramics with diamond discs
surface and subsurface damage are induced which have the potential of lowering the strength of the ceramic. Careful
polishing steps should be carried out after grinding especially when dealing with glass-ceramics.

Reprinted with permission of The Academy of Dental Materials.

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