JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No.

1 (118 - 124): An Experimental Analysis of the Stresses on the Implant in an I

An Experimental Analysis of the Stresses on the

Implant in an Implant-Tooth–Supported Prosthesis:
A Technical Note
Hakan Uysal, DDS, PhD/Haldun 7plikçioJlu, DDS, PhD/Mehmet Avcs, DDS, PhD/Ömer Gündüz
Bilir, BSc, MS, PhD/Oktay Kural, DDS, PhD

When a natural tooth connected to an implant abutment by a framework is displaced within

physiologic limits under functional loads, the superstructure acts as a cantilever moment arm
and the implant is loaded additionally during that moment effect. The effects of a deflecting
support connected to an IMZ implant, with either the IMC resilient or the titanium rigid
element, were evaluated through an experimental model. The strain values measured when the
moment arm was not allowed to deflect were only 30% lower than the strains measured when
it was deflected within the limits of physiologic tooth mobility. The IMC was effective and
achieved a reduction in the cervical strains up to 60% when compared with the rigid
connector.
(INT J ORAL MAXILLOFAC IMPLANTS 1997;12:118–124)
Key words: biomechanics, dental implant, stress analysis

O ne treatment option for a partially edentulous patient involves the connection of a natural tooth
to an osseointegrated implant. However, the difference between the axial mobility of a healthy
natural tooth and an implant has been considered to be a biomechanical deficiency of this
system.1,2 To accommodate the mobility features of the two different types of support in these
situations, the use of resilient systems has been suggested.1,3 The efficacy of different resilient
systems in the stress transfer characteristics of implants for both free-standing and
implant-tooth–supported situations has been investigated by using different methods. 4-11
The first report of osseointegrated implants ad modum Brånemark in combination with natural teeth
did not show any significant failures during an observation of 6 to 10 months.12 The results of another
2-year longitudinal study by Åstrand et al13 revealed no disadvantage to connecting teeth and rigid
implants in the same restoration. In a study with a follow-up time of 16.5 months, Kramer and Weber 14
demonstrated the absence of any clinical differences between a mobile superstructure and a rigid
superstructure on IMZ implants connected to a natural abutment. In an in vivo study, O’Leary et al 15
noted that the rigid attachment of a natural tooth to an implant had been well tolerated, both clinically
and histologically. Although strong theoretical rationale and valuable results on the efficacy of resilient
systems have been published, the question of whether to use a rigid or a resilient system is yet to be
conclusively answered.
From the biomechanical point of view, the disadvantage of connecting an implant to a natural tooth is
the formation of additional stresses on implants produced by the moment forces. As the natural tooth,
which is fixed to an implant abutment by a framework, is displaced within physiologic limits under
functional loads, the superstructure acts as a cantilever arm and the implant is loaded with an additional

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JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No. 1 (118 - 124): An Experimental Analysis of the Stresses on the Implant in an I

force during the moment effect.2,3 To determine the biomechanical requisite for a resilient implant
system to be used in the treatment of partially edentulous patients, the significance of additional stresses
on the implant abutment should be understood.
The aim of the present study was to evaluate the effects of the moment action on the implant
abutment when connected to a deflecting support. The study was designed to compare the stresses
produced on the implant when either a deflecting or a nondeflecting support was connected to the
abutment.
Materials and Methods
To simulate the direction and amount of displacement of a natural tooth under an occlusal force, an
experimental model was designed (Figs 1 and 2a). The model consisted of an implant (IMZ, Interpore
International, Irvine, CA) embedded into acrylic resin with a metal bar fixed to an implant abutment,
representing the superstructure of the complex. The superstructure was made by casting the direct waxup
of coping components. The metal bar had two flattened surfaces for loading measurements of
displacement (Fig 1). The superstructure arm was related to an inclined plane so as to represent a support
that could be deflected under force and a horizontal support that did not let the arm deflect in any
direction (Figs 2a and 2b).
Rationale of Test Model. In implant-tooth–supported prostheses, displacement of the tooth in
occlusogingival and buccolingual directions causes the superstructure to act as a moment arm and
produce moment forces in both directions. While deflection in the buccolingual direction causes shear
forces along the entire implant-bone interface,16 the axial component of the moment action causes axial
stresses in the implant body. To demonstrate the additional stresses developed by the moment action until
terminal mobility is reached at the tooth support, the resultant displacement of the moment arm at its end
should be well determined and controlled. The amount of deflection at the moment arm is primarily
determined by the resultant mobility of a natural tooth abutment. It has been shown that the physiologic
limits of tooth mobility are 25 to 28 µm in the occlusogingival direction and 175 to 200 µm in the
buccolingual direction.17,18 According to the components of the applied force onto the system, the path
of displacement of a tooth in its socket would change. With out taking into consideration the path that a
tooth follows until it reaches its final position in its socket, an inclined plane was used to control the ratio
of displacement in the moment arm in both directions. As the load was applied on the superstructure, the
moment arm could be diverted by the inclined plane with a guidance derived from the ratio of mobility
limits in both directions. To prevent friction, the metal bar had a wheel at its end, and this wheel
maintained contact with the inclined plane (Fig 1).
It has been shown that the resilience of an osseointegrated implant is approximately 10 to 100 times
higher, when compared with a healthy natural tooth. 19 To simulate any situation in which there is no
deflection relative to the tooth abutment, a horizontal support was used (Fig 2b).
Test Loading. Experiment 1 involved the effects of moment arm deflections on the implant abutment
(Figs 1 and 2a). The inclined plane was used to support the system and let the moment arm deflect. Static
loads of 10, 20, 35, 80, 100, 125, 150, and 200 N were applied by a loading apparatus (SL 1, Tuna Mak,
Ankara, Turkey) onto the preselected notch (F N), which was 15 mm away from the central axis of the
abutment. The test loads were applied three times in sequence. The horizontal displacement of the arm
during the loading was measured by a dial gauge (Mitutoya, Tokyo, Japan) with 1/1,000 mm sensitivity
(Figs 2a and 3). The measuring point was just below the loading point on the flattened lateral surface of

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the superstructure arm.

Experiment 2 involved the connection of an implant to a comparably nondeflecting support. The
horizontal support replacement prevented the deflection of the superstructure arm in any direction. The
same sequence of loading as in experiment 1 was applied at the preselected notch (FN). Both the inclined
and the horizontal planes were made of the same material.
Both of the experiments were executed by using either the resilient or rigid internal elements.
Measurement of Strains. The experiment was set up on an IMZ implant system (Interpore
International, Irvine, CA) that used either an IMC as a resilient component or a titanium rigid
interchangeable element. To record strain data at the cervical level of the implant, two-element 90-degree
rosette gauges (FCA-1-11, Tokyo Sokki Kenkyujo, Tokyo, Japan) were bonded with an adhesive (P2,
Tokyo Sokki Kenkyujo) to the lateral surface at the compression side of the implant (Fig 4). The implant
with the gauges bonded was embedded into self-curing resin up to its cervical level. The bonded gauge
was not covered with any coating material before embedding to provide direct support of the resin
material. The strains were measured via the strain gauge by a strain indicator (Vishay Instruments,
Raleigh, NC). The bond between the gauge and the implant was intact in every loading sequence of the
study to provide reliable data. To check the maintenance of the Poisson ratio through the entire
experiment, the lateral and axial strains were recorded simultaneously during the first loading sequence
in experiment 1 and during the last loading sequence in Experiment 2. Before each loading, a stress-free
implant condition was tested through the strain indicator.
Results
The presence of deflection caused a mean increase of 35% in strain when compared with no deflection
for either element. The resilient element provided up to 60% decrease in strain in both experiments
(Table 1) (Fig 5).
Deflection of the moment arm in experiment 1 was much higher in the IMZ resilient group than in the
IMZ rigid group (Table 1) (Fig 6).
The lateral and the axial strain values are shown in Table 2. The ratio of lateral strains to axial strains
was 0.346 ± 0.005 in experiment 1 (the rigid group), which involved the first loading sequence in the
study, and 0.338 ± 0.014 in experiment 2 (the resilient group), which was the last sequence of loading in
the study. The ratios of lateral to axial strains in the first and last sequences of loading are presented in
Fig 7.
Discussion
Brunski20 has stated that one of the problems in assessing an implant-tooth–supported system has been
the lack of experimental data. The results obtained from a simplified biomechanical model would depend
entirely on the assumed biomechanical behavior of the tooth and implant abutments. Brunski also noted
that experimental evaluation of resilient systems would require careful measurements of both tooth and
implant abutments. Experimental studies on the efficacy of resilient systems for both free-standing and
implant-tooth-supported situations are sparse.
An experimental model to analyze stresses on an implant that is fixed to a deflecting support should
simulate and measure the mobility of both supports under forces and detect simultaneous changes in
stress data. In the present experimental model, deflection of the superstructure at its end by the
displacement of the natural tooth abutment under occlusal force is simulated through a mechanical

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complex that allows the superstructure to have a repeatable and measurable deflection. The strain gauge
on the compression side of the implant at the cervical level was very precise in detecting the minor
changes in strain data dependent on the internal element used and amount of deflection. The ratio of the
lateral strains to the axial strains, which were measured simultaneously, provided the Poisson ratio of the
implant material. It remained unchanged throughout the first to the last test loading sequence in the
experiment (see Table 2, Fig 7). This was important for the validity and reliability of the study because it
indicated that the shear force between the gauge and the resin had not affected the bond between gauge
and implant. As the Poisson ratio was achieved after each test loading, it assured that the bonding of the
gauge to the implant surface remained intact.
The strain values measured when the moment arm was not permitted to deflect were only 30% lower
than the strains measured when the moment arm deflected under the guidance of the inclined plane (see
Table 1, Fig 5). The IMC was very effective in both experiments and achieved a reduction of up to 60%
in cervical strain when compared to the rigid connector (see Table 1, Fig 5). With a biomechanical
approach, it may be acceptable to use resilient connectors to compensate for the additional 30% increase
in stresses. However, the system is mainly supported by the bone when the terminal mobility is achieved
by the natural tooth. The strain versus load graphs for the rigid group in experiment 1 indicate a different
slope when the maximal deflection in the moment arm is produced (see Fig 5). In this experimental
model, deflection of the moment arm has been determined by the mechanical properties of resin and the
total friction within the wheel-plane complex. Clearly, the necessary amount of vertical force to deflect
the arm in a clinical situation can widely differ, since it depends on the mobility features of the tooth
support, the mechanical properties of the implant-bone relation, and the mechanical properties of the
bone itself around the implant. In this experimental model, for the rigid group in experiment 1, a resultant
lateral deflection of 172 µm and a simultaneous axial deflection of 25 µm in the superstructure moment
arm was achieved by 125 N of vertical force (see Table 1, Fig 6). After that loading, the strain versus
load graph could be expected to demonstrate a different slope (see Fig 5). This line would tend to be
parallel to the line of the rigid group in experiment 2 because the system would be carried by
nondeflecting supports.
The amount of vertical force necessary to gain 175 µm of lateral deflection at the end of the
superstructure arm in this model was around 85 N for the resilient group (see Fig 6). In a clinical
situation, if the implant system still had the ability to deflect beyond this loading point, the natural tooth
would be expected to support the rest of the occlusal forces within the upper limits. It has been
previously noted that there might be excessive mobility in the IMZ system with the IME as a resilient
component. If it is connected to the natural tooth, the tooth support would bear the overwhelming portion
of the occlusal strains and stresses.21 The IMC has been shown to have less mobility against horizontal
stresses than has the IME.22 However, it seems that in restorations supported by a combination of teeth
and IMZ implants (integrating IMC), an important portion of the intraoral forces are still apt to affect the
natural tooth support. To provide complete accommodation in the implant and natural tooth supports, the
resilient systems should provide limited mobility.
The applied loads in the present study were of static character and within the loading range used.
Results demonstrated a linear relationship between load and strain. However, the practical system
involves dynamic loading in function and the fatigue characteristics of the materials. The effects of
fatigue loading around the implant, as well as the endurance limit of the implant attachment components,
should be studied in implant-tooth–supported prostheses for both deflecting and nondeflecting implant
designs.

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Conclusions
1. The strains measured when the moment arm was not allowed to deflect were found to be 30% lower
than the strains measured when the moment arm was deflected, within the limits of tooth mobility in
the lateral and axial directions.
2. IMC was effective and achieved a reduction of up to 60% in cervical strains when compared to the
rigid connector. In this experimental model, the IMC let the superstructure deflect at the upper limits
of tooth mobility by axial forces, which can be considered to be within the lower limits of intraoral
forces. To prevent the natural tooth abutment from sustaining the overwhelming portion of the rest of
the loads, the resilient system should provide limited mobility.

Hakan Uysal

Assistant Professor, Department of

Prosthodontics, Çukurova University, Faculty of
Dentistry, Adana, Turkey.

Haldun IplikçioJlu

Assistant Professor, Department of

Prosthodontics, Hacettepe University, Faculty of
Dentistry, Ankara, Turkey.

Mehmet Avci

Associate Professor, Department of

Prosthodontics, Hacettepe University, Faculty of
Dentistry, Ankara, Turkey.

Ömer Gündüz Bilir

Professor, Department of Mechanical Engineering,

Middle East Technical University, Faculty of
Engineering, Ankara, Turkey.

Oktay Kural

Footnotes 5
 Professor, Department of Prosthodontics,
Hacettepe University, Faculty of Dentistry, Ankara,
Turkey.

FIGURES

Figure 1

Fig. 1 Experimental model with implant, superstructure, and inclined plane. The inclined plane
is substituted for the horizontal surface for the second experiment.

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Figure 2a-b

Figs. 2a and 2b Diagram of implant connected to (left) the inclined plane, which allows the
superstructure arm to deflect in both lateral and axial direction, and (right) the horizontal plane
(FN = loading at the notch, S = superstructure, I = implant, IP = inclined plane, HP = horizontal
plane, DG = dial gauge, RG = rosette gauge).

Figure 3

Fig. 3 Static axial loading of superstructure by the loading apparatus and the measurement of
lateral deflection at the moment arm by dial gauge.

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Figure 4

Fig. 4 IMZ implant with rosette gauge bonded to its lateral surface at cervical level.

Figure 5

Fig. 5 Effects of deflecting support and resilient connector on the strains.

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Figure 6

Fig. 6 Effects of resilient connector on the lateral deflection of the superstructure arm.

Figure 7

Fig. 7 Relation between ratio of lateral to axial strains in the first and last sequences of loading.

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TABLES

Table 1

Tables 10
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Table 2

An Experimental Analysis of the Stresses on the Implant in an Implant-Tooth-

1. Richter EJ. Basic biomechanics of dental implants in prosthetic dentistry. J Prosthet Dent 1989;61:602–609.
2. Skalak R. Aspects of biomechanical considerations. In: Brånemark P-I, Zarb GA, Albrektsson T (eds).
Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence, 1985:117–128.
3. Sullivan D. Prosthetic considerations for the utilization of osseointegrated fixtures in partially edentulous arch.
Int J Oral Maxillofac Implants 1986;1:39–45.
4. McGlumphy EA, Campagny WV, Peterson LJ. A comparison of the stress transfer characteristics of a dental
system with a rigid or a resilient internal element. J Prosthet Dent 1989;62:586–593.
5. French AA, Bowles CQ, Parham PL, Eick JD, Killoy WJ, Cobb CM. Comparison of peri-implant stresses
transmitted by four commercially available osseointegrated implants. Int J Periodont Rest Dent
1989;9:221–246.
6. Holmes DC, Haganman CR, Aquilino SA. Deflection of superstructure and stress concentrations in the IMZ
implant system. Int J Prosthodont 1994;7:239–246.
7. Holmes DC, Grigsby WR, Goel VK, Keller JC. Comparison of stress distribution in the IMZ implant system
with polyoxymethylene or titanium element: A finite element analysis. Int J Oral Maxillofac Implants
1992;7:450–458.
8. El Charkawi HG, El Wakad MT, Naser ME. Modification of osseointegrated implants for distal extension
prostheses. J Prosthet Dent 1990;64:469–472.
9. Hata Y, Watanabe F, Fukuda H, Hamamatsuka Y, Nisiyama K. Stress analysis of intermobile element by three
dimensional finite element [abstract 69]. J Dent Res 1990;69:117.
10. Ismail JY. A comparison of current root form implants. Biomechanical design and prosthodontic applications.
NY State Dent J 1989 Apr;36(4):35–36.

References 11
JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No. 1 (118 - 124):

11. Siegele D, Soltesz U. Implantate mit intramibilen einsatzen als bruckenfeiler. Z Zahnarztl Implantol
1986;2:117–124.
12. Ericsson I, Lekholm U, Brånemark P-I, Lindhe J, Glantz P-O, Nyman S. A clinical evaluation of fixed bridge
restorations supported by the combination of teeth and osseointegrated implants. J Clin Periodontol
1986;13:307–312.
13. Åstrand P, Borg K, Gunne J, Olsson M. Combination of natural teeth and osseointegrated implants as
prosthesis abutments: A 2-year longitudinal study. Int J Oral Maxillofac Implants 1991;6:305–312.
14. Kramer A, Weber H. The effect of bedding type on implant and abutment tooth in tooth-implant supported
bridgework. Dtsch Zahnarztl Z 1991;46:686–688.
15. O’Leary TJ, Dykema RW, Kafrawy AH. Reactions to osseointegrated implants rigidly attached to natural teeth
[abstract 1911]. J Dent Res 1990;69:347.
16. Bidez MW, Misch CE. Force transfer in implant dentistry: Basic concepts and principles. J Oral Implantol
1992;18:264–274.
17. Picton DCA, Wills DJ. Viscoelastic properties of the periodontal ligament and mucous membrane. J Prosthet
Dent 1978;40:263–272.
18. Mühlemann HR. Ten years of tooth mobility measurements. J Periodontol 1960;31:110–122.
19. Spiekermann H. Implantatprotetik. In: Voss R, Meiners H (eds). Fortschritte der zahnaerztlichen prothetik und
werkstoffkunde, ed 2. Munich: Hanser, 1984:189–218.
20. Brunski JB. Biomaterials and biomechanics in dental implant design. Int J Oral Maxillofac Implants
1988;3:85–97.
21. Haris AG, Mozsary PG. A new concept: CODAR (Complete osseointegrated dento-alveolar replacement) and a
corresponding dental design (Flexiroot). Oral Implantol 1986;12:630–660.
22. Nakanishi T, Saratoni K, Kusumoto T, Tanaka M, Oka H, Kawazae T. Comparison with two kinds of
intramobile element in IMZ implant [abstract 699]. J Dent Res 1993;72:191.

References 12