Copyright © 2018 American Scientific Publishers Journal of

All rights reserved Biomaterials and Tissue Engineering

Printed in the United States of America Vol. 8, 962–971, 2018

Micromotion of Immediately Loaded Zirconia Dental

Implants for Various Parametric Conditions:
A Three-Dimensional Finite Element Study
Duraisamy Velmurugan and Masilamany Santha Alphin∗
Department of Mechanical Engineering, SSN College of Engineering, Chennai 603110, Tamil Nadu, India
RESEARCH ARTICLE

Excessive micromotion may cause failures in osseointegration between the implant and bone. This
study investigated the influence of various mechanical parameters on micromotion at the bone-
implant interface for Zirconia dental implants in three dissimilar bone qualities (type II, type III, and
type IV) under immediate loading conditions. A three-dimensional finite element model of a dental
implant and bone block was developed and implemented for determining micromotion in terms of
relative displacement at the bone-implant interface. Finite element simulations were conducted for
different implant thread designs and loading direction. Results of this study suggest that the vertical
displacement is sensitive to implant thread design and loading direction. Under the application of
a vertical load, the displacement had a positive correlation with thread pitch and helix angle and a
negative correlation with thread compactness. The implant stability was restricted in type II bone
and it was increased in type III and type IV bone under the influence of horizontal loading for all
the cases considered. The cancellous bone density, when compared to the cortical bone thickness,
had less influence on micromotion at the bone-implant interface. The influence of thread patterns
on micromotion was varied in accordance with the bone type.
Keywords: Finite Element Analysis, Immediate Load, Dental Implant, Micromotion, Zirconia.

1. INTRODUCTION directed towards the impact of immediate loading of the

The innovation of osseointegrated dental implants in den-
tistry represents a turning point in clinical dental prac-
tice. The stability of the implant is an important factor to
achieve the success rate and longevity of implants. Hence,
achieving primary stability is one of the most impor-
tant, crucial objectives during implantation, followed to
the loading of the implant. The primary stability of the
implant is influenced by bone quantity and quality, surgi-
cal techniques, and the implant geometry.1 An insufficient
primary stability leads to implant failure.2 Moreover, den-
tal implants are designed to obtain primary stability so that
successful osseointegration can be achieved.3 4 An unin-
terrupted healing phase of three-six months is required for
successful implant osseointegration in conventional den-
tal implant restoration.5–7 However, this method has been
proven to be extremely successful, as a prolonged treat-
ment phase may be observed as a considerable inconve-
nience. Immediate loading of dental implants has currently
acquired popularity due to several factors, including abate-
ment in the treatment time. Hence, the research focus is
∗
Author to whom correspondence should be addressed.
dental implants.8 Literature shows that the success rate
of immediate loading implants is acceptable9 10 however,
for single tooth restoration, an immediate loading of the
implant induces a lower survival rate and a higher risk
of failure.11 12 These drawbacks are due to micromotion
at the bone-implant interface, which may occur when a
non-osseointegrated implant is subjected to an immediate
loading or due to forces acting on the implant.13 There is
no influence of osseointegration if the micromotion at the
bone-implant interface is in the range of 50–150 m.14
Micromotion over 150 m may cause micro-bleeding,
which may induce the formation of fibrous encapsulation
of the implant. Hence, micromotion at the bone-implant
interface is considered as a potential risk factor for suc-
cessful osseointegration.15 16
Variations in dental implant design have been suggested
to improve the survival rate of immediate loading,
by achieving primary stability and restricting micromo-
tions. The thread design should maximize initial contact,
improve initial stability and create a better distribution
of stress.17 Thread depth, width, pitch, helix and face
angle are other important geometric variables used to

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Velmurugan and Alphin Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
determine the effects of biomechanical loads and bone
implant contact.18 19 Hence, it is important to consider
implant thread profile for advancement of dental implant
systems. Implant thread pitch is considered as an impor-
tant design parameter because of its influence on surface
interactions and insertion speed.20 It has been reported that
the micromotion at the bone-implant interface is influenced
by the thread pitch and its compactness.21 However, there
are no previous studies done to clarify the effect of thread
pitch and thread compactness on primary stability of Zir-
conia dental implants subjected to immediate loading for
different qualities of the bone.
Micromotion is the crucial factor which determines the
initial stability of dental implants. However, the displace-
ment at the bone-implant interface is difficult to mea-
sure using a clinical device. Nevertheless, the primary
stability of dental implants has been represented by sev-
eral factors and these factors including insertion torque,22
removal torque, and pull out force23 are used in clini-
cal or experimental studies. However, the sensitivity and
relation between these parameters are uncertain.24 Experi-
mental methods for determining micromotion at the bone-
implant interface are limited. The finite element (FE) study
is a powerful numerical technique for analysis of micro-
motion at the implant-bone interface.25–27 Therefore, the
primary goal of this study was to analyze the biomechan-
ical effects of different thread designs on micromotion at
Fig. 1. Study workflow.
J. Biomater. Tissue Eng. 8, 962–971, 2018
the bone-implant interface for different bone qualities, by
using a three-dimensional FE model of a dental implant
and bone block.
2. MATERIALS AND METHODS
2.1. Methodology
All methods were carried out in accordance with relevant
guidelines and regulations. A schematic illustration of the
proposed study, to estimate the relative displacement at the
bone-implant interface for three dissimilar bone qualities
(type II, type III, and type IV) under immediate loading
conditions, is shown in Figure 1. The geometries of the
bone block and dental implant were modelled using a 3D
modelling software and imported to a FE analysis solver
to develop a FE model of the bone-implant setup. At first,
RESEARCH ARTICLE
FE simulations were conducted on the type II bone under
vertical loading for the following cases: (i) single threaded
dental implant with 0.8 mm pitch, (ii) single threaded den-
tal implant with 1.6 mm pitch, (iii) single threaded dental
implant with 2.4 mm pitch, (iv) double threaded dental
implant with 1.6 mm pitch, and (v) triple threaded den-
tal implant with 2.4 mm pitch. Then, the FE simulations
were carried out on type III and type IV bones for the
aforementioned cases under vertical loading condition. At
last, the FE simulations were repeated on type II, type III,
and type IV bones under horizontal loading condition for
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 Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions Velmurugan and Alphin

Table I. Classification of implant groups.

Group name Description Parameters considered

Group I Distinct pitches Single threaded implant with

0.8 mm pitch, 1.6 mm pitch, and
2.4 mm pitch
Group II Different helix Single threaded implant with
angles, similar 0.8 mm pitch, double thread
thread compactness implant with 1.6 mm pitch, and
triple threaded implant with
2.4 mm pitch
Group III Same helix angle, Single and double threaded implant
different thread with 1.6 mm pitch, single and
compactness triple threaded implant with
2.4 mm pitch
RESEARCH ARTICLE

the cases discussed above. The relative displacement at

the bone-implant interface was evaluated for each case
considered.
Fig. 3. Representation of coordinate points on the implant-bone finite
2.2. FE Model of the Bone-Implant Setup element model.

The premolar mandible bone block and screw type implant

with abutment were designed using 3D modelling software
(SolidWorks Corp; Concord, MA, USA 2016). To examine
the effect of thread helix and compactness of single, dou-
ble, and triple threaded Zirconia dental implants, five dis-
tinct V-shaped implants (3.7 mm diameter, 10 mm length,
0.3 mm collar height, helix angle = 60  ) were designed.
Different pitch values were adopted with a thread spac-
ing of 0.8 mm to differentiate the implant designs and
these values are 0.8 mm, 1.6 mm, and 2.4 mm for single
threaded pitch; 1.6 mm for double threaded pitch; 2.4 mm
for triple threaded pitch. These designs are classified into
three groups in order to simplify the analysis as shown in
Table I.
A portion of the mandibular region was only considered
for this analysis to reduce the computational cost. There
are four different bone qualities, according to Lekholm and
Zarb’s classification.28 In this study, types II, III, and IV
bones were considered for analysis, since type I bone con-
sists only of the cortical bone. The thickness of cortical
bone layer has been varied to differentiate the type of
bones. In type II model, a core of dense cancellous bone
was surrounded by a thick layer of cortical bone with a
thickness of 2 mm. A uniform geometric configuration is
obtained for types III, IV and II models, but the thickness
of the cortical bone layer is reduced to 1 mm, as shown
in Figures 2(a)–(b). In type III model, a core of dense
cancellous bone was surrounded by a thin layer of cor-
tical bone with a thickness of 1 mm. In type IV model,
a core of low-density cancellous bone was surrounded by
a thin layer of 1 mm cortical bone thickness in type IV
model. Three coordinate points were marked as shown in
Figure 3 and these points are considered as nodal points in
meshing. The geometries of the bone and implants were
transferred to the HyperMesh (Altair Engineering, Troy,
MI, USA) software to build a FE model using 4 node tetra-
hedral elements for later study. The number of elements
and nodes in each model are listed in Table II. The devel-
oped FE models were exported to the FE analysis software

Table II. Number of nodes and elements meshed for each implant
model.

Thread type Pitch (mm) Bone type Elements Nodes

Single threaded 0.8 Type II 575512 118774

Type III, Type IV 660953 132671
Single threaded 1.6 Type II 666401 132149
Type III, Type IV 640966 127723
Single threaded 2.4 Type II 670158 132265
Type III, Type IV 643307 127580
Double threaded 1.6 Type II 679720 135950
Type III, Type IV 656836 131982
Triple threaded 2.4 Type II 696111 138940
Type III, Type IV 661446 132603
Fig. 2. Configuration of dental implant-bone model.

964 J. Biomater. Tissue Eng. 8, 962–971, 2018

Velmurugan and Alphin Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
Table III. Mechanical properties of materials used in the study.
Materials Young’s modulus (GPa) Poisson ratio
Cortical bone 13.7 (29)
Dense cancellous bone 1.37 (29)
(Type II, Type III)
Low-dense cancellous bone 0.231(29)
Zirconia 210 (31)
ANSYS Mechanical APDL17 (ANSYS, Inc.; Canonsburg,
PA, USA) for performing simulations.
The materials used for this FE study are considered as
linearly elastic, homogeneous and isotropic. The mechan-
ical properties of the FE element models were adopted
from the available literature, as shown in Table III.29–31
The boundary conditions on the mesial, distal, and bottom
surfaces of the bone block were completely constrained.32
The implant-bone interface was defined by using contact
elements (Contact 174) to simulate immediately loaded
implants. The coefficient of friction was set as 0.3.33
A vertical load of 200 N and a horizontal load of 100 N
was applied along the axis of the implant, and the centre
of the abutment surface.
2.3. Relative Displacement Calculation
In order to determine the relative displacement, the con-
cept of calculating the distance between two points on the
three dimensions of the XY Z plane has been adopted. By
following the same, the relative displacement between the
two nodes (nodes of the implant interface and the cor-
responding bone interface) of the elements of the inter-
face is used to evaluate the micromotion. If x1 , y1 , z1 are
coordinates at the implant interface; x2 , y2 , z2 are coor-
dinates at the bone interface, the relative displacement =
√ 2.4 mm pitch single threaded implant, it was increased by
X 2 + Y 2 + Z2 .
Where
X = x1 − x2  Y = y1 − y2  Z = z1 − z2
Fig. 4. Results of convergence study in the single threaded dental implant with 0.8 mm pitch in type II bone.
J. Biomater. Tissue Eng. 8, 962–971, 2018
3. RESULTS
3.1. Mesh Convergence
A mesh convergence study was performed to ascertain the
0.3
0.3 prediction accuracy of the FE model was not affected by
the chosen mesh element size. The resulting convergence
0.3 criterion of less than 2% change in peak displacement of
0.24 the implant between the number of elements in mesh at a
given load was observed (Figs. 4(a, b)).
3.2. Micromotion at the Bone-Implant Interface
Due to Vertical Load
The influence of the type of load (vertical, horizontal) on
micromotion in terms of displacement is listed in Table IV.
The results of each implant type are reported individually.
In group I, it has been observed that, the single threaded
RESEARCH ARTICLE
implant with minimum pitch (0.8 mm) induced minimum
micromotion than the implants with the maximum pitch
(2.4 mm) in type II and type III bones. However, the
similar kind of result was not observed in type IV bone
(Fig. 5(a)). The micromotion was increased by 24.5% in
type II bone, 43.2% in type III bone, whereas it was
decreased by 24.9% in type IV bone for the 1.6 mm pitch
single threaded implant. The micromotion was increased
by 32.6% in type II bone, 45.8% in type III bone, whereas
it was decreased by 19.2% in type IV bone for the 2.4 mm
single threaded implant when compared to the 0.8 mm
pitch of single threaded implant. In addition to this, the
micromotion of the 0.8 mm pitch single threaded implant
was increased by 56% in type III bone and 357.6% in
type IV bone in comparison with a similar pitch in type II
bone. In the same manner, the micromotion of the 1.6 mm
pitch single threaded implant was increased by 84.3% in
type III bone and 176% in type IV bone, whereas for the
76.2% in type III bone and 180.2% in type IV bone.
In group II, the triple threaded implant induced a
lesser micromotion than the 0.8 mm pitch single threaded
implant (Fig. 5(b)). The micromotion of the double
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 Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions Velmurugan and Alphin

Table IV. Relative displacement of implants under vertical and horizontal load.

Type II Type III Type IV

Relative displacement (m) Relative displacement (m) Relative displacement (m)

Thread design Vertical load Horizontal load Vertical load Horizontal load Vertical load Horizontal load

Single threaded 0.8 mm pitch 9815 4516 15726 11638 44908 34697
Single threaded 1.6 mm pitch 12214 6246 22522 11457 33733 33802
Single threaded 2.4 mm pitch 12988 8786 22930 10320 36349 32482
Double threaded 9551 5692 15885 9604 29350 32008
Triple threaded 8996 7638 15342 9857 38271 32959

threaded implant was decreased by 3.1% in type II bone;
however, it was increased by 1.3% in type III bone and
34.7% in type IV bone and for the triple threaded implant,
it was decreased by 8.2% in type II bone, 2.5% in type III
RESEARCH ARTICLE
to the 1.6 mm pitch single threaded implant (Fig. 5(c)).
In addition to this, compared with 2.4 mm pitch single
threaded implant, the micromotion of the triple threaded
implant is decreased by 30.8% in type II bone, 33.1% in

bone, and 14.7% in type IV bone when compared to the
0.8 mm pitch single threaded implant. Additionally, for
the similar conditions of the similar thread profile, the
micromotion of the double threaded implant was increased
by 66% in type III bone, and 207.3% in type IV bone,
whereas for the triple threaded implant it was increased by
70% in type III bone, and 325.7% in type IV bone.
In group III, the micromotion of the double threaded
implant was decreased by 22.1% in type II bone, 29.3% in
type III bone, and 13.1% in type IV bone when compared
type III bone, whereas, it was increased by 5.2% in type IV
bone.
3.3. Micromotion at the Bone-Implant Interface
Due to Horizontal Load
In group I, the 0.8 mm pitch of single threaded implant
gives minimum micromotion in type II bone compared to
the 2.4 mm pitch single threaded implant (Fig. 6(a)). Fur-
thermore, the 2.4 mm pitch single threaded implant gives
the minimum micromotion in bone types III and IV than

Fig. 5. Relative displacement (micromotion) induced at the bone-implant interface under the application of vertical load. (a) Group 1 (the pitch
group), (b) group 2 (the helix angle group), and (c) group 3 (the compactness group).

966 J. Biomater. Tissue Eng. 8, 962–971, 2018

Velmurugan and Alphin Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
Fig. 6. Relative displacement (micromotion) induced at the bone-implant interface under the application of horizontal load. (a) Group 1 (the pitch
group), (b) group 2 (the helix angle group), and (c) group 3 (the compactness group).
the 0.8 mm pitch of single threaded implant. The micromo-
tion of the 1.6 mm single threaded implant was increased
by 37.6% in type II bone, whereas, it was decreased by
1.7% in type III bone, and 2.6% in type IV bone; in addi-
tion to this, the micromotion of the 2.4 mm pitch of single
threaded implant was increased by 95.2% in type II bone,
and it was decreased by 11.2% in type III bone, and 6.3%
in type IV bone when compared to the 0.8 mm pitch of
single threaded implant. Under the same thread profile,
the micromotion of the 0.8 mm single threaded implant
was increased by 157.2% in type III bone and 668.7% in
type IV bone as compared with that for the same pitch
in type II bone. Similarly, for the 1.6 mm pitch single
threaded implant the micromotion was increased by 83.3%
in type III bone, and 441.9% in type IV bone, and for the
2.4 mm pitch single threaded implant it was increased by
18.3% in type III bone, and 271.3% in type IV bone.
In group II, the triple threaded implant produces the
minimum micromotion in types III and IV bones, but it
gives the maximum micromotion in type II bone when
compared to the 0.8 mm pitch single threaded implant
(Fig. 6(b)). The micromotion of the double threaded
implant was increased by 26.6% in type II bone, and it
was decreased by 17.2% in type III bone, and 7.8% in
type IV bone when compared to the 0.8 mm pitch single
J. Biomater. Tissue Eng. 8, 962–971, 2018
RESEARCH ARTICLE
threaded implant. For the triple threaded implant, it was
increased by 68.6% in type II bone, and it was decreased
by 15.5% in type III bone, and 4.9% in type IV bone
(Figs. 7(a–f)). Under the similar conditions of the simi-
lar thread profile the micromotion of the double threaded
implant was increased by 68.5% in type II bone, and
462.1% in type IV bone. The micromotion of the triple
threaded implant was increased by 28.8% in type III bone,
and 331.2% in type IV bone (Figs. 7(b, c, e, f)).
In group III, compared with the 1.6 mm pitch single
threaded implant, the relative displacement of the double
threaded implant was decreased by 9.6%, 16.6%, and 5.3%
in bone types II, III, and IV, respectively (Fig. 6(c)). Fur-
thermore, related with the 2.4 mm single pitch threaded
implant, the micromotion of the triple threaded implant
was decreased by 12.5%, 4.8% in types II, and III bones,
whereas it was increased by 1.5% in type IV bone.
4. DISCUSSION
The FE analysis has been widely used for biomechan-
ical analyses that are difficult to perform using other
methods. Similar to other biomechanical problems related
to implant dentistry, the FE analysis may be regarded
as an important tool to examine micromotion.34 Hence,
the present study used the FE analysis to examine the
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 Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
RESEARCH ARTICLE
Fig. 7. (a–f) Contour plots showing the lateral displacement (mm) induced by a triple threaded implant on the bone-implant setup for various bone
qualities.
influence of implant thread profile on micromotion in var-
ious bone qualities. Furthermore, no previous studies have
focused on the effect of Zirconia implant on micromo-
tion at the bone-implant interface. Hence, in this study,
Zirconia ceramic material properties were applied to the
implant. In line with previous studies focused on micro-
motion analyses, this study used the relative displacement
of the implant as a parameter which is considered as most
appropriate to examine micromotion. The Resonance fre-
quency analysis (RFA) method has been employed by
many researchers35 36 to study the micromotion; how-
ever, the changes in micromotion are influenced by the
RFA value indirectly. In comparison with the RFA value,
the relative displacement has an impact on micromotion
directly.
Considering the limited experimental capabilities in the
dentistry field, FE analysis is considered as an opportune
method for assessing micromotion at the bone-implant
interface.37 38 FE simulations can provide necessary infor-
mation (both qualitative and quantitative) to study the
biomechanical behaviour of dental implants.39 40 Be that
as it may, a few suppositions should be made to simulate
968
Velmurugan and Alphin
real conditions, and these can prompt distortion of the
FE model. The validity of FE model is reliant on the
geometry, material properties, contact conditions, bound-
ary conditions, and loading conditions.41 42 The contact
at the bone-implant interface is very consequential, espe-
cially for the loading conditions we considered in this
study43 (immediate loading). Most FE based studies in
the dentistry field have simulated friction elements at the
bone-implant interface.34 44 45 Therefore, in this study, the
contact at the bone-interface interface was modelled using
friction elements. Since material properties likewise have
a vital effect on the result, the elastic modulus (Young’s
modulus) for type IV cancellous bone was taken from pre-
operative patient data based on lab tests.46
The accuracy of results obtained from the FE model is
reliant on the FE mesh used. In this study, HyperMesh was
used to create a high-quality mesh by following a two-
step meshing process. In the first step, two-dimensional
surface elements were created by meshing the line into
elements. In the second step, three-dimensional elements
were created from two-dimensional surface elements. Most
FE based studies in the biomedical engineering field have
J. Biomater. Tissue Eng. 8, 962–971, 2018
Velmurugan and Alphin Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
used the main solver (ANSYS or ABAQUS) to create FE
mesh.39–45 We manually inspected the FE mesh model cre-
ated by ANSYS and found irregular and deformed ele-
ments, while the FE mesh model created by HyperMesh
was free from irregular and deformed elements. A mesh
sensitivity study was performed to ascertain the prediction
accuracy was not affected by the number of elements used
in the mesh (Figs. 4(a, b)).
The micromotion induced at the implant collar region
was found to be the maximum under a vertical load than
a horizontal load, which is contrasted with the clinical
assumption47 which show that implant stability is influ-
enced by horizontal loading and not by vertical loading.
Moreover, regardless of the type of load applied, the rel-
ative displacement of the implants significantly increased
when bone density was reduced (Type II > Type III >
Type IV) and this finding is in line with a previous work.48
The influence of various pitches (group I) on the micromo-
tion of the implants was analyzed. The major difference
was observed in micromotion of the implant under hor-
izontal and vertical loading for different values of pitch.
This implies that the stability of the implant is influenced
by pitch variation and this is in good agreement with a
previous experimental study.21 Thus far, the influence of
the helix angle, compactness of the thread on micromotion
has not been published clearly. It has been observed that
the lesser relative displacement is found for the 0.8 mm
pitch single threaded implant than for the triple threaded
implant in type II bone, regardless of load type. Despite
that, this condition has been reversed in bone types III
and IV. Hence, this contrast should be investigated further
and this finding indicates that the helix angle and compact-
ness of the thread have a significant influence on the initial
stability of the implant. Additionally, the implant resis-
tance to vertical and horizontal loads reduced in type II
bone. In low-density bones (types III and IV), the implant
resistance to the load increases when the helix angle of the
thread is increased.
The effect of implants with the same helix angle, but
distinct thread compactness (Group III) was also analyzed
in this study. Results show that the micromotion in the
collar region of the double and triple threaded implant
was lesser than that of the 1.6 mm, 2.4 mm pitch single
threaded implants, regardless of the load type. It shows that
irrespective of the type of bones, the implant resistance to
horizontal and vertical loads decreases as the compactness
of the thread increases.
The finding of this study also shows that, in group I, the
micromotion of the 1.6 mm, 2.4 mm pitch single threaded
implant in the collar region was increased by 24.5% and
32.6% in type II bone, and 43.2% and 45.8% in type III
bone, and it was decreased by 24.9% and 19.2% in type IV
bone under vertical load when a comparison was made
with the 0.8 mm pitch single threaded implant. Under hor-
izontal load, the micromotion of the 1.6 mm, 2.4 mm
J. Biomater. Tissue Eng. 8, 962–971, 2018
pitch single threaded implant was increased by 37.6% and
95.2% in type II bone; however, it was decreased by 1.7%
and 11.2% in type III bone, and 2.6% and 6.3% in type IV
bone respectively. The similar results were also found in
groups II and III. This proves that a vertical load had more
influence than a horizontal load on the thread pitch, helix
angle, and compactness. These findings also show that the
impact of the thread pitch, helix angle, and compactness
is restricted to type II bone under vertical load. The per-
centage reduction in relative displacement was found in
types III and IV bones under horizontal load. This indi-
cates that, in horizontal load, the impact of the thread
profile on implant stability was increased in type III bone
where the compact bone thickness is found to be mini-
mum. In addition to this, when comparing types III and IV
(low-density bone), the significant increment was found
RESEARCH ARTICLE
between two bones in micromotion under horizontal load.
Hence, it has been concluded that the density of bone had
less influence on micromotion than compact bone thick-
ness. These findings are in good agreement with previous
studies49–51 which shows that cortical bone thickness has
a major influence in determining implant primary stabil-
ity. The study also indicates that the micromotion of the
0.8 mm pitch single threaded implant was increased by
357.6% and 668.7% in type IV bone respectively, under
vertical and horizontal loads when compared with the
same type of implant in type II bone. In the same man-
ner, the relative displacement of the 2.4 mm pitch single
threaded implant was increased by 180.2% and 271.3%
in type I bone under vertical and horizontal loads, when
compared with the same type of implant in type II bone.
Similar results are also found in groups II and III as in
group I. This indicates clearly that, the micromotion of the
implant is varied for distinct bone qualities by the influ-
ence of various parameters considered in this study.
There are some limitations associated with this FE
study. The material properties of the bone models were
assumed to be homogeneous, isotropic, and linearly elas-
tic. However, the assumption of inhomogeneous and
anisotropic bone properties may result in different micro-
motion between the implant and bone. Also, the implant-
bone interface was defined by using a frictional contact.
A static load was applied to the finite element model to
examine the micromotion, but in realistic occlusal load is
dynamic. Hence, the result of this study must be viewed
carefully, and the limitations of this study should also
be considered when applying these results to the clinical
setting.
5. CONCLUSION
In this study, micromotion between the bone and implant
has been studied by considering various parameters and
Zirconia as a dental implant material. Within the limita-
tions of this FEA study for evaluation of implant micro-
motion, the following conclusions were made.
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 Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions Velmurugan and Alphin

1. The micromotion of the implant was influenced by var-
ious parameters including thread pitch, the angle of helix,
and compactness of the thread.
2. The implant was found to be more stable in type II
bone than types III and IV bone. Hence, the cortical bone
thickness plays an important role in examining the primary
stability of the implant.
3. Thread pitch and helix angle have a positive correla-
tion with micromotion, while thread compactness has a
negative correlation with micromotion.
4. Dental implants positioned in distinct bone qualities
show variations in the micromotion in terms of percentage.
This contrast should be investigated further.
5. Zirconia as a dental implant material has gained atten-
tion recently. Hence, further research is required to know
more about the impact of various dental biomaterials on
RESEARCH ARTICLE
of the edentulous jaw, experience from a 10-year period. Scand J.
Plast Reconstr. Surg. Suppl. 16, 1 (1977).
6. R. Adell, U. Lekholm, B. Rockler, and P. I. Brånemark, A 15-year
study of osseointegrated implants in the treatment of the edentulous
jaw. Int. J. Oral Surg. 10, 387 (1981).
7. T. Albrektsson, G. Zarb, P. Worthington, and A. R. Eriksson, The
long-term efficacy of currently used dental implants: A review and
proposed criteria of success. Int. J. Oral Maxillofac. Implants 1, 11
(1986).
8. J. L. Wennstrom, A. Ekestubbe, K. Gröndahl, S. Karlsson, and
J. Lindhe, Implant-supported single-tooth restorations: A 5-year
prospective study. J. Clin Periodontol. 32, 567 (2005).
9. N. J. Attard and G. A. Zarb, Immediate and early implant loading
protocols: A literature review of clinical studies. J. Prosthet. Dent.
94, 242 (2005).
10. E. Nkenke and M. Fenner, Indications for immediate loading of
implants and implant success. Clin. Oral Implants Res. 17, 19
(2006).

11. C. E. Misch, H. Wang, C. M. Misch, M. Sharawy, J. Lemons, and

micromotion at the bone-implant interface. K. W. M. Judy, Rationale for the application of immediate load in
implant dentistry: Part I. Implant. Dent. 13, 207 (2004).
12. E. Ioannidou and A. Doufexi, Does loading time affect implant sur-
Author Contributions vival? A meta-analysis of 1,266 implants. J. Periodontol. 76, 1252
Conceptualization: DV and MSA (2005).
Data curation: DV and MSA 13. G. E. Romanos, Present status of immediate loading of oral implants.
J. Oral Implantol. 30, 189 (2004).
Data analysis: DV
14. S. Szmukler-Moncler, H. Salama, Y. Reingewirtz, and J. H.
FE simulation: DV and MSA Dubruille, Timing of loading and effect of micromotion on bone den-
Methodology: DV and MSA tal implant interface: Review of experimental literature. J. Biomed.
Project administration: MSA Mater. Res. 4, 192 (1998).
Supervision: MSA 15. S. Szmukler-Moncler, A. Piattelli, G. A. Favero, and J. H. Dubruille,
Writing-original draft: DV and MSA Considerations preliminary to the application of early and immediate
loading protocols in dental implantology. Clin Oral Implants Res.
Writing-review and editing: DV and MSA. 11, 12 (2000).
16. P. Trisi, G. Perfetti, E. Baldoni, D. Berardi, M. Colagiovanni, and
Additional Information G. Scogna, Implant micromotion is related to peak insertion torque
The author(s) declare no competing financial interests. and bone density. Clin Oral Implants Res. 20, 467 (2009).
17. C. J. Ivanoff, K. Gröndahl, L. Sennerby, C. Bergström, and
U. Lekholm, Influence of variations in implant diameters: A 3- to
Funding 5-year retrospective clinical report. Int. J. Oral Maxillofac Implants
This research work did not receive any specific grant from 14, 173 (1999).
funding agencies in the public, commercial, or not-for- 18. C. E. Misch, Dental Implant Prosthetics, St Louis, Mosby (2005),
pp. 322–347.
profit selectors.
19. J. P. Geng and X. X. Ma, A differential mathematical model to
evaluate side-surface of an archimede implant. Shanghai Shengwu
Disclaimers Gongcheng Yixue 50, 19 (1995).
None. 20. J. T. Steigenga, K. F. Al-Shammari, F. H. Nociti, C. E. Misch, and
H. L. Wang, Dental implant design and its relationship to long term
implant success. Implant Dent. 12, 306 (2003).
References and Notes 21. M. Akkocaoglu, S. Uysal, I. Tekdemir, K. Akca, and M. C. Cehreli,
1. M. Atsumi, S. H. Park, and H. L. Wang, Methods used to assess Implant design and intraosseous stability of immediately placed
implant stability: Current status. Int. J. Oral Maxillofac Implants implants: A human cadaver study. Clin Oral Implants Res. 16, 202
22, 743 (2007). (2005).
2. G. E. Romanos, Surgical and prosthetic concepts for predictable 22. D. O’Sullivan, L. Sennerby, and N. Meredith, Measurements com-
immediate loading of oral implants. J. Calif. Dent. Assoc. 32, 991 paring the initial stability of five designs of dental implants:
(2004). A human cadaver study. Clin. Implant Dent. Relat. Res. 2, 85 (2000).
3. F. Javed, H. B. Ahmed, R. Crespi, and G. E. Romanos, Role of 23. H. Kido, E. E. Schulz, A. Kumar, J. Lozada, and S. Saha, Implant
primary stability for successful osseointegration of dental implants: diameter and bone density: Effect on initial stability and pull-out
Factors of influence and evaluation. Interv. Med. Appl. Sci. 5, 162 resistance. J. Oral Implantol. 23, 163 (1997).
(2013). 24. H. A. da Cunha, C. E. Francischone, H. N. Filho, and R. C. G. de
4. R. Jimbo, N. Tovar, C. Marin, H. S. Teixeira, R. B. Anchieta, L. M. Oliveira, A comparison between cutting torque and resonance fre-
Silveira, M. N. Janal, J. A. Shibli, and P. G. Coelho, The impact quency in the assessment of primary stability and final torque capac-
of a modified cutting flute implant design on osseointegration. Int. ity of standard and TiUnite single-tooth implants under immediate
J. Oral Maxillofac. Surg. 7, 883 (2014). loading. Int. J. Oral Maxillofac Implants 19, 578 (2004).
5. P. I. Brånemark, B. O. Hansson, R. Adell, U. Breine, J. Lindström, 25. P. Chang, Y. Chen, C. Huang, W. Lu, and H. Tsai, Distribution
O. Hallén, and A. Ohman, Osseointegrated implants in the treatment of micromotion in implants and alveolar bone with different thread

970 J. Biomater. Tissue Eng. 8, 962–971, 2018

Velmurugan and Alphin Micromotion of Immediately Loaded Zirconia Dental Implants for Various Parametric Conditions
profiles in immediate loading: A finite element study. Int. J. Oral
Maxillofac Implants 27, e96 (2012).
26. A. Fazel, S. Aalai, M. Rismanchian, and P. Sadr-Eshkevari, Micro-
motion and stress distribution of immediate loaded implants: A finite
element analysis. Clin Implant Dent. Relat. Res. 11, 267 (2009).
27. J. T. Hsu, L. J. Fuh, D. J. Lin, Y. Shen, and H. Huang, Bone strain
and interfacial sliding analyses of platform switching and implant
diameter on an immediately loaded implant: Experimental and three-
dimensional finite element analyses. J. Periodontol. 80, 1125 (2009).
28. U. Lekholm and G. A. Zarb, Patient selection and preparation,
Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry,
edited by P. I. Brånemark, G. A. Zarb, and T. Albrektsson,
Quintessence, Chicago (1985), pp. 199–209.
29. D. C. Holmes and J. T. Loftus, Influence of bone quality on stress
distribution for endosseous implants. J. Prosthet Dent. 23, 104
(1997).
30. C. L. Lin, J. C. Wang, and Y. C. Kuo, Numerical simulation on the
biomechanical interactions of tooth/implant-supported system under
various occlusal forces with rigid/non-rigid connections. J. Biomech.
39, 453 (2006).
31. M. Guazzato, M. Albakry, S. P. Ringer, and M. V. Swain, Strength,
fracture toughness and microstructure of a selection of all-ceramic
materials, Part II, zirconia-based dental ceramics. Dent. Mater.
20, 449 (2004).
32. J. C. Wu, C. Chen, S. Yip, and M. Hsu, Stress distribution and micro-
motion analyses of immediately loaded implants of varying lengths
in the mandible and fibular bone grafts: A three dimensional finite
element analysis. Int. J. Oral Maxillofac Implants 27, e77 (2012).
33. W. Winter, D. Klein, and M. Karl, Effect of model parameters on
finite element analysis of micromotions in implant dentistry. J. Oral
Implantol. 39, 23 (2013).
34. H. C. Kao, Y. W. Gung, T. F. Chung, and M. L. Hsu, The influ-
ence of abutment angulation on micromotion level for immediately
loaded dental implants: A 3-D finite element analysis. Int. J. Oral
Maxillofac Implants 23, 623 (2008).
35. M. Bischof, R. Nedir, S. Szmukler-Moncler, J. Bernard, and
J. Samson, Implant stability measurement of delayed and imme-
diately loaded implants during healing. Clin Oral Implants Res.
15, 529 (2004).
36. N. Meredith, Assessment of implant stability as a prognostic deter-
minant. Int. J. Prosthodont. 11, 491 (1998).
37. W. Winter, S. Möhrle, S. Holst, and M. Karl, Parameters of implant
stability measurements based on resonance frequency and damping
capacity: A comparative finite element analysis. Int. J. Oral Max-
illofac. Implants 25, 532 (2010).
38. W. Winter, P. Steinmann, S. Holst, and M. Karl, Effect of geometric
parameters on finite element analysis of bone loading caused by non-
passively fitting implant-supported dental restorations. Quintessence
Int. 42, 471 (2011).
J. Biomater. Tissue Eng. 8, 962–971, 2018
39. D. Z. Shamami, A. Karimi, B. Beigzadeh, M. Haghpanahi, and
M. Navidbakhsh, A 3D finite element study for stress analysis in
bone tissue around single implants with different materials and var-
ious bone qualities. J. Biomater. Tissue Eng. 6, 632 (2014).
40. D. Z. Shamami, A. Karimi, B. Beigzadeh, S. Derakhshan, and
M. Navidbakhsh, A three-dimensional finite element study to char-
acterize the influence of load direction on stress distribution in bone
around dental implant. J. Biomater. Tissue Eng. 4, 693 (2014).
41. D. Shriram, G. P. Kumar, F. Cui, Y. H. D. Lee, and K. Subburaj,
Evaluating the effects of material properties of artificial meniscal
implant in the human knee joint using finite element analysis. Sci.
Rep. 7, 6011 (2017).
42. D. Shriram, R. Parween, Y. H. D. Lee, and K. Subburaj, Effects
of counteracting external valgus moment on lateral tibial cartilage
contact conditions and tibial rotation. Conf. Proc. IEEE Eng. Med.
Biol. Soc. 2017, 1625 (2017).
43. N. Murakami and N. Wakabayashi, Finite element contact analysis as
a critical technique in dental biomechanics: A review. J. Prosthodont
RESEARCH ARTICLE
Res. 58, 92 (2014).
44. M. G. Tu, J. T. Hsu, L. J. Fuh, D. J. Lin, and H. L. Huang, Effects
of cortical bone thickness and implant length on bone strain and
interfacial micromotion in an immediately loaded implant. Int. J.
Oral Maxillofac Implants 25, 706 (2010).
45. T. Sugiura, K. Yamamoto, S. Horita, K. Murakami, S. Tsutsumi, and
T. Kirita, Effects of implant tilting and the loading direction on the
displacement/micromotion of immediately loaded implants: In vitro
experiment and finite element analysis. J. Periodontal Implant Sci.
47, 251 (2017).
46. T. Sugiura, K. Yamamoto, M. Kawakami, S. Horita, K. Murakami,
and T. Kirita, Influence of bone parameters on per-implant bone
strain distribution in the posterior mandible. Med. Oral Patol Oral
Cir. Bucal. 20, e66 (2015).
47. R. Gapski, H. Wang, P. Mascarenhas, and N. P. Lang, Critical review
of immediate implant loading. Clin. Oral Implants Res. 14, 515
(2003).
48. K. Wang, D. H. Li, J. F. Guo, B. L. Liu, and S. Q. Shi, Effects of
buccal bi-cortical anchorages on primary stability of dental implants:
A numerical approach of natural frequency analysis. J. Oral Rehabil.
36, 284 (2009).
49. Y. Su, B. Wilmes, R. Honscheid, and D. Drescher, Application of a
wireless resonance frequency transducer to assess primary stability
of orthodontic mini-implants: An in vitro study in pigilia. Int. J. Oral
Maxillofac. Implants 24, 647 (2009).
50. J. Roze, S. Babu, A. Saffarzadeh, M. Gayet-Delacroix, A. Hoornaert,
and P. Layrolle, Correlating implant stability to bone structure. Clin.
Oral Implants Res. 20, 1140 (2009).
51. H. G. Yoon, S. J. Heo, J. Y. Koak, S. K. Kim, and S. Y. Lee, Effect
of bone quality and implant surgical technique on implant stability
quotient (ISQ) value. J. Adv. Prosthodont. 3, 10 (2011).
Received: 11 April 2018. Accepted: 13 May 2018.
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