The Effect of Implant Thread Design on

Stress Distribution in Anisotropic Bone with

Different Osseointegration Conditions:
A Finite Element Analysis
Alireza Mosavar, BSc1/Alireza Ziaei, BSc1/Mahmoud Kadkhodaei, PhD2

Purpose: Whereas bone is anisotropic, nearly all previous mechanical analyses of implants assumed bone
as an isotropic material. Another means to simplify a simulation of the biomechanics of the implant-bone
interface is the assumption of complete or no osseointegration; in clinical reality, an implant never achieves
100% contact with the surrounding bone. This study evaluated different thread profiles while not taking
into account these two common simplifications. This study sought to (1) investigate the effects of various
implant thread designs on stress distribution in the peri-implant bone, (2) appraise previous efforts in this
area, and (3) find an optimum basic thread-form design. Materials and Methods: Through finite element
analysis, four different basic commercial thread-form configurations for a solid screw-type implant were
modeled: buttress, reverse buttress, V, and square. Bone was assumed to be transversely isotropic, and
various degrees of osseointegration were simulated. Results: Simulations showed that von Mises stresses
were more distributed in the mesiodistal direction. Additionally, maximum stresses were concentrated at
the cervical cortical bone region and the first thread. Moreover, in most of the models, von Mises stresses
gradually increased in the supporting structure when the degree of osseointegration increased. Conclusion:
The use of different thread designs and various osseointegration conditions did not affect the stress
distribution patterns in the supporting bone. In this study, square threads showed the most favorable results
according to the predicted values of von Mises equivalent stress, pressure, different shear stresses, and
micromotion. Int J Oral Maxillofac Implants 2015;30:1317–1326. doi: 10.11607/jomi.4091

Key words: bone anisotropy, dental implants, finite element analysis, osseointegration, thread design

D ental implants function to transfer load to their

surrounding biologic tissues. Thus, the primary
functional design objective is to manage (dissipate and
distribute) biomechanical loads to optimize the func-
tion of the implant-supported prosthesis.1 The con-
figuration of implant threads is an important element
in the biomechanical optimization of dental implants.2
Thread geometry may differ according to pitch, depth,
and shape.1 Although thread pitch and depth may af-
fect stress distribution, manufacturers have traditional-
ly provided a constant pitch and depth in their implant
1Research Assistant, Department of Mechanical Engineering,
Isfahan University of Technology, Isfahan, Iran.
2 Associate Professor, Department of Mechanical Engineering,
Isfahan University of Technology, Isfahan, Iran.
Correspondence to: Dr Mahmoud Kadkhodaei, Department
of Mechanical Engineering, Isfahan University of Technology,
Isfahan, 84156-83111, Iran. Fax: +98-31-33912628.
Email: kadkhodaei@cc.iut.ac.ir
©2015 by Quintessence Publishing Co Inc.
systems. Consequently, for commercial implant sys-
tems, better designs of thread configuration have
been emphasized.3 The thread design must maximize
initial contact, improve initial stability, enhance surface
area, and facilitate dissipation of stresses at the bone-
implant interface.4
The long-term success of dental implant treatment
relies on proper stability of the implant within the host
bone. This condition is achieved through osseointegra-
tion, which is characterized as a direct functional and
structural connection between ingrown bone tissue
and the implant surface.5,6 Secondary stability is usually
considered to be full osseointegration between the im-
plant and the surrounding bone, and thus, full (100%)
contact between the bone and implant is often as-
sumed in the existing biomechanical approaches.3–5,7,8
However, this is inconsistent with clinical reality, in that
full osseointegration does not occur; within the peri-
implant bone, certain areas show no bone-to-implant
contact.6 Hence, the effects of partial osseointegration
between an implant and its surrounding bone on the
performance of the implant need to be investigated.

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Mosavar et al
There is a lack of numeric simulations of the bone-
implant interaction for various osseointegration con-
ditions in the literature. The approach presented by
Papavasiliou et al9 suggests that properties of cortical
and cancellous bone must be assigned to the portion
of bone that is integrated with the implant, whereas
properties of connective tissue, which has very low
stiffness, should be assigned to the nonosseointegrat-
ed portion. On the other hand, Natali et al10 and Win-
ter et al11 proposed a transitional region between the
implant and the remaining peri-implant bone structure
to more accurately represent clinical conditions during
the healing process.
Finite element analysis (FEA) is generally considered
an acceptable tool to simulate the biomechanics of
peri-implant bone. It offers many advantages over oth-
er methods in simulating the complexities of the clini-
cal situation.8 Whereas the parameters of an FE model
can be simplified because FEA is inherently used as an
approximation tool, the quality of the results critically
depends on how real and applicable the simplifica-
tions are. In previous attempts to determine an opti-
mal thread configuration, two common simplifications
have been made in modeling the peri-implant bone
biomechanics, which may seriously affect outcomes.
The first simplification is considering the bone to be
isotropic. In reality, bone has different mechanical prop-
erties when measured in different directions, which
means that bone is in fact an anisotropic material. The
other simplification frequently used to simulate sec-
ondary stability is full osseointegration, with a bonded
constraint condition between the implant and the sur-
rounding bone assumed; as a consequence, no sliding
or separation between faces or edges is allowed. This
assumption is in contrast with clinical observations.
In brief, almost all previous numeric analyses of
implant-bone interactions and implant geometric
characteristics employed either one or both incorrect
assumptions (bone isotropy and complete or no osseo-
integration). Furthermore, in the few studies that did
model anisotropic bone, only the von Mises stresses,
which are not sufficient for analysis of an anisotropic
material, were debated. In other words, they did not
consider the anisotropic stress components individual-
ly in their investigations. Thus, the published outcomes
under such unrealistic fundamental assumptions are
not dependable. In the current study, various partial
osseointegration conditions and anisotropic bone
were considered so that a more applicable simulation
could be carried out. The bone was assumed to be
transversely isotropic. With FEA, a mandibular premo-
lar section and implants with four different thread-form
designs were modeled. The amounts of stress and strain
in peri-implant bone induced by occlusal loading were
investigated, and the effects of different implant thread
1318 Volume 30, Number 6, 2015
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designs on stress distribution and micromotion in the
supporting structures were examined. Various tools
(von Mises equivalent stress, anisotropic stress compo-
nents, pressure, different shear stresses, and micromo-
tion) were employed to analyze the outcomes. The main
aim of the current study was to determine an optimum
basic thread design among four studied thread profiles.
In addition, previous investigations were evaluated to
compare the simplifications used in existing studies
against the assumptions used in the present study.
MATERIALS AND METHODS
This study is based on three-dimensional FEA; the the-
ory of elasticity is applied, and no separations are al-
lowed between the bone and the implant. The first step
in a numeric analysis is to create three-dimensional
geometric models of the jawbone and the studied im-
plants. A detailed model of a jawbone was generated
using axial computed topography (CT) for conversion
into a computer-aided design model. Then, to make
the simulation cost efficient, a section in the premolar
region of mandible was selected; this contained a thin
(2-mm) layer of cortical bone surrounding a core of
dense cancellous bone according to the Lekholm and
Zarb classification.12 The mesial and distal sectional
planes were not covered by the cortical bone. Based on
the Kurniawan et al6 method, a transition region was
introduced within the jawbone. This method is expect-
ed to better represent peri-implant bone conditions
by adapting the approaches that introduce a bone-
implant transition region.9–11 The transition region is
a section of jawbone adjacent to the implant that lies
beyond the outermost geometry of the implant. In
this study, it was set 0.5 mm from the implant’s inner
diameter and proportionally toward its apical region. It
was defined as a separate section, which included both
cortical and cancellous bone, consisting of implant-
cortical and implant-cancellous transition areas. A frac-
tion of bone properties was assigned to these parts to
represent partial osseointegration6 (Fig 1).
The bone was considered to be anisotropic, since
it shows different mechanical properties when mea-
sured in different directions. However, an approxima-
tion may be applicable because the elastic moduli of
cortical bone in the buccolingual and inferosuperior
directions are not significantly different13,14 and those
of cancellous bone in the buccolingual and mesiodistal
directions are similar.13,15 Considering these facts, bone
can be assumed to be transversely isotropic. Therefore,
only five independent elastic properties, instead of 21
for general anisotropic materials, were derived from
the generalized Hooke’s law. To simulate the material
properties of transversely isotropic peri-implant bone
 Mosavar et al

Implant-cortical Table 1  Material Properties for the Transversely Isotropic

transition region Bone with Differing Degrees of Osseointegration6
Cortical bone Cancellous bone Cortical bone
Property 50% 75% 100% 50% 75% 100%
Young’s Ex 574 861 1,148 9,700 14,550 19,400
modulus Ey 574 861 1,148 6,300 9,450 12,600
(E) (MPa) Ez 105 157.5 210 6,300 9,450 12,600
Poisson νxy 0.32 0.32 0.32 0.253 0.253 0.253
ratio (ν) 0.01 0.01 0.01 0.253 0.253 0.253
νxz
Implant-cancellous νyz 0.05 0.05 0.05 0.3 0.3 0.3
transition region Shear Gxy 217 325.5 434 2,850 4,275 5,700
modulus Gxz 34 51 68 2,850 4,275 5,700
Cancellous bone
(G) (MPa) Gyz 34 51 68 2,425 3,637.5 4,850
Fig 1  Sectional view of implant, cortical and
cancellous bone, and transition regions.

5.0 mm 6.0 deg

4.0 mm
0.4 mm
4.8 mm
2.4 mm

0.4 mm 0.3 mm
3.5 mm

a b c d 4.1 mm 12.0 mm

Fig 2   The four solid screw-type implants studied and their dif-
ferent thread designs. (a) buttress, (b) reverse buttress, (c) V, 1.5 mm
and (d) square.

Fig 3 (right)  Schematic illustration of geometric parameters

used for the implant and its abutment.

in the mandibular premolar region, the elastic proper-
ties of cortical and high-density cancellous bone were
used based on the approach of O’Mahony et al13 (Table
1). These values were used for properties of the remain-
ing cortical and cancellous bone. Various degrees of
osseointegration were featured in the transition region
(50%, 75%, and 100%). Partial osseointegration was
represented by fractional values of the elastic and shear
moduli for cortical and cancellous bone at a constant
Poisson ratio (Table 1).6 The considered anisotropic co-
ordinate system of the bone aligns with the global co-
ordinate system, in which the x-axis is in the mesiodistal
direction, the y-axis is in the buccolingual direction, and
the z-axis is set in the inferosuperior direction.
There are no commercially available implants with
thoroughly identical geometries but different thread
profiles; however, this type of correspondence is vital
to determine the effect of thread design alone. Hence,
the geometry of Straumann (Institut Straumann) solid
implants was used as a reference to build models of
dental cylindric screw-type implants with four differ-
ent commercially available thread-form configura-
tions: buttress, reverse buttress, V, and square (Fig 2).16
A solid abutment was considered as one unit with the
implant.11,17,18 This simplification does not affect the
results, since, in this study, only the stress and strain
in the peri-implant bone were considered and those
in the implant were not of concern. It is also a usual
practice, when modeling peri-implant bone biome-
chanics, to consider a solid implant without internal
details,6,11,17,18 and this assumption was also imple-
mented in the present study. This is plausible, since a
relatively minor vacant space exists within the implant
system, and all parts of the implant are composed
of the same material. The geometry of the implant is
shown in Fig 3. The titanium implant (together with its
abutment) was assumed to have a Young’s modulus of
110 GPa and a Poisson ratio of 0.35.6

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Mosavar et al
Pressure load
Boundary
constraint
Fig 4  Illustration of three-dimensional FE model, load appli-
cation, and boundary conditions. Arrows and ties represent
schematics of load application and boundary constraints,
respectively.
With respect to the implant-bone contact and the
appropriate constraints for FE modeling, the experi-
mental evidence remains too limited to determine the
most realistic interface boundary condition.17,19 Nev-
ertheless, removal torque tests of implants with rough
surface treatments over a machined surface have fre-
quently resulted in fracture within the bone far from
the implant surface,20 and this suggests the existence
of an implant-bone “bond.”21 This study modeled an
implant with a rough surface; therefore, a bonded or
merged condition with a “tie” constraint was set at the
interface with the bone. According to Kurniawan et al,6
the distinctive feature of the proposed approach is that
the contact occurs between the implant and the tran-
sition region, not between the implant and the bulk
of the bone directly; thus, perfect osseointegration is
not necessarily assumed. The same constraint was ap-
plied between the transition regions and the remain-
ing bone, as well as at the cortical-cancellous bone
interface.
To simplify calculations, no crown was included in
the analysis.4 This is not critical for two important rea-
sons. First, the stresses and strains in the peri-implant
bone, not those in the implant, were the subject of the
study. Second, owing to the relatively high stiffness of
a crown (either porcelain or nickel-chromium alloy),
the applied occlusal load would be distributed almost
evenly to the abutment. The occlusal load in the cur-
rent study was presumed to be a compressive stress.4,6
In the normal human dentition without implants, the
average magnitudes of maximal vertical (axial) bite
forces are 469 ± 85 N in the canine region, 583 ± 99 N
in the second premolar region, and 723 ± 138 N in the
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second molar region.22 Moreover, Woodmansey et al23
reported that the maximum bite force was around 500
N in the area of the mandibular molars in patients with
normal occlusion with an implant-supported prosthe-
sis. Consequently, in the present work, a vertical oc-
clusal load of about 410 N was applied statically to
the implant on the occlusal surface of the abutment
as a 60-MPa compressive stress. The boundary condi-
tions were set as fully constrained on the buccal and
lingual inferior surfaces4,24 (Fig 4). A middle-support
boundary condition in an FEA model is more com-
parable with clinical observations of retrieved dental
implants.3
The FE modeling was accomplished on a personal
computer with CATIA software (version 5.20, Dassault
Systems). All the parts were meshed using Abaqus
FEA software (version 6.12-1, Dassault Systems/Simu-
lia Corp). The models were meshed automatically with
quadratic 10-node tetrahedral solid elements (C3D10
elements) (Fig 4) using a nonstandard interior ele-
ment growth rate of 1.50 for time and cost efficien-
cy. To include convergence tolerance, 5% tolerance
was permitted for the maximum von Mises stresses
in both cortical and cancellous bone. The analysis of
each model was performed on a personal computer
with Abaqus FEA software.
RESULTS
The stress distribution contours of the cortical bone,
cancellous bone, and transition regions in the reverse
buttress thread design model with 50% degree of os-
seointegration are shown in Fig 5a. The first thing to
notice is a wider affected area by the generated stress
in the mesiodistal direction in comparison with the
buccolingual direction. The stress distribution pattern
throughout the bone was nearly identical for all of the
thread design models and degrees of osseointegra-
tion. However, the distribution of stresses was more
even in cancellous bone than in cortical bone. As seen
in detail in Fig 5b, the maximum stress values were
concentrated in the cortical bone’s cervical region
next to the implant and in the cortical bone structure
adjacent to the first thread. This was seen for all stud-
ied implants in spite of the different thread designs. In
addition, a relatively small amount of stress appeared
in the cancellous bone, even within the threads.
The maximum von Mises stresses observed in corti-
cal and cancellous bone as well as the related transi-
tion regions are listed in Table 2. It is clear from the
data that the stresses in cortical bone, most notably
the transition region within the cortical bulk bone ad-
jacent to the implant, were several times greater than
those in cancellous bone. The results indicate that, for
 Mosavar et al

Fig 5a  Buccolingual cross section showing the stress dis- Fig 5b   Detailed view of Fig 5a showing the stress concentra-
tribution pattern within the supporting bone structure of the tion around the implant neck and within the first thread in the
implant with reverse buttress threads in conditions of 50% cortical bone.
osseointegration.

Table 2  Maximum von Mises Stresses Induced in Peri-implant Bone

Stress in transition region (MPa) Stress in bulk bone (MPa)
Osseointegration
Thread type (%) Cortical bone Cancellous bone Cortical bone Cancellous bone
Buttress 50 130.5 22.40 42.69 4.946
75 133.3 23.71 44.17 5.003
100 146.1 24.58 47.68 5.264
Reverse 50 119.5 10.82 41.19 5.181
buttress 75 136.2 10.66 44.25 5.311
100 149.0 10.46 47.76 5.440
V 50 118.1 8.680 41.24 5.075
75 134.8 8.970 44.36 5.217
100 147.6 9.110 47.88 5.332
Square 50 112.7 15.78 44.50 7.088
75 130.2 16.95 48.52 7.616
100 143.6 17.77 52.60 8.049

a specified thread type, an increase in the degree of os-
seointegration gave rise to an increase in the amount
of stress. As can be seen, the maximum amounts of
stress corresponded to the cortical transition region
with 100% osseointegration. In addition, the maxi-
mum stress values in the cancellous bone and its tran-
sition region were lower than those in the respective
cortical areas. Also, for a specified thread design, the
variation of stress values in the cancellous bone with
change in the degree of osseointegration was below
7.5%. The effect of thread configuration on the can-
cellous bone stress was not considerable; however,
the square threads induced relatively higher stress.
The same condition was seen in cortical bone. In the
cancellous transition region, the reverse buttress and
V-thread configurations had roughly the same effect.
Moreover, buttress and square thread configurations
led to the highest stresses, sequentially. In the cortical
transition region, which needs further consideration
owing to its closeness to the implant and the rela-
tively higher stresses seen, the square thread design
seemed to induce the least stresses in each osseointe-
gration condition. A more detailed comparison of the
results for stress components in the cortical transition
region is listed in Table 3.
Shown in Fig 6 are the shear stress distributions
in the cortical bone, cancellous bone, and transition
regions around the implant with reverse buttress
threads at 50% osseointegration. In this figure, Sij rep-
resents shear in the positive j direction on a section
with its normal vector in the i-axis. Like the von Mises
stresses, the distribution patterns for shear stresses
were similar for all thread designs and degrees of os-
seointegration in the entire bone; however, the inten-
sity of the stresses and the affected area varied. It can
be seen that, for all models regardless of thread design,
the maximum shear stresses appeared in the cervical
cortical bone adjacent to the implants, in the corti-
cal bone adjacent to the first thread, and at the coro-
nal interface between cortical and cancellous bone.
Moreover, within the threaded region, a small amount
of shear stress developed in the cancellous bone.

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Mosavar et al

Table 3  All Stress Components in Implant-Cortical Bone Transition Region

Sxx (MPa) Syy (MPa)

Osseointegration
Thread type (%) Max Min Max Min
50 112.0 –98.77 99.13 –144.2
Buttress 75 113.4 –109.5 112.0 –164.7
100 113.8 –118.1 121.1 –180.2
50 76.74 –97.44 106.8 –147.5
Reverse buttress 75 80.70 –107.0 112.4 –168.0
100 84.94 –114.5 120.5 –183.6
50 96.14 –96.01 97.68 –145.8
V 75 96.69 –105.3 110.9 –166.1
100 96.47 –112.4 120.3 –181.4
50 109.2 –93.47 93.88 –140.0
Square 75 111.5 –103.9 107.7 –161.6
100 113.2 –112.0 117.6 –178.0
The maximum stress in each case refers to tensile stress, and the minimum stress refers to compressive stress.

a b c
Fig 6   Buccolingual cross-sectional views of shear stress distribution in the supporting bone of the reverse buttress thread for 50%
osseointegration: (a) Sxy, (b) Syz, (c) Sxz.

Shown in Fig 7a to 7c are the maximum resultant
shear stresses generated in each model for 50%, 75%,
and 100% osseointegration, respectively. The highest
shear stresses were seen in the implant-cortical bone
transition region and increased with an increase in the
degree of osseointegration. In addition, the maximum
stress values in cancellous bone were much lower
than those in cortical bone.
Figure 8 illustrates the distribution of compressive
stress (pressure). This distribution pattern was almost
the same for all thread designs, and the maximum
pressure values occurred at the implant neck. More-
over, the highest compressive stress was generated in
the implant-cortical bone transition region for each
bone structure. Figure 9 shows the maximum com-
pressive stress for different degrees of osseointegra-
tion; it can be seen that the stresses increased with
increases in the degree of osseointegration. In ad-
dition, the maximum stress values in the cancellous
bone were minimal in comparison with those in corti-
cal bone.
Shown in Fig 10 are the maximum displacements
in the bone structure. The highest displacements
occurred in the transition regions. Moreover, any in-
crease in the degree of osseointegration led to a de-
crease in the amount of displacement.

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 Mosavar et al

Szz (MPa) Sxy (MPa) Sxz‌(MPa) Syz (MPa)

Max Min Max Min Max Min Max Min
56.72 –56.17 38.63 –39.22 26.51 –36.48 42.2 –40.52
49.88 –65.83 43.46 –43.92 30.40 –35.32 49.1 –46.44
44.88 –73.76 46.99 –47.40 33.65 –35.83 54.7 –51.33
43.23 –56.85 39.85 –39.21 26.67 –25.64 46.75 –40.38
40.38 –66.14 44.66 –43.75 30.30 –29.23 49.96 –46.62
44.13 –73.69 48.21 –47.06 33.31 –32.24 55.48 –52.02
45.74 –69.51 42.70 –39.17 26.39 –30.21 42.33 –41.04
40.38 –66.56 44.13 –43.77 29.94 –29.66 48.87 –47.16
44.18 –72.44 47.67 –47.20 32.85 –31.89 54.14 –52.27
34.08 –54.56 36.59 –38.65 25.17 –39.51 40.68 –39.59
39.58 –64.56 41.72 –43.61 28.96 –42.49 47.84 –45.79
43.70 –72.72 45.67 –47.25 32.07 –44.64 53.66 –50.96

120 
Sxy Syz Sxz 140  Sxy Syz Sxz
100  120 
100 
Stress (MPa)

Stress (MPa)
80 
80 
60 
60 
40  40 
20  20 
0  0 
I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI

a Region b Region

Fig 7   Amounts of maximum shear stresses in the bone struc-

ture for (a) 50%, (b) 75%, and (c) 100% osseointegration. I = but-
140  Sxy Syz Sxz
tress thread, cancellous transition region; II = reverse buttress
120 
thread, cancellous transition region; III = V thread, cancellous
transition region; IV = square thread, cancellous transition re-
Stress (MPa)

100 
gion; V = buttress thread, cortical transition region; VI = reverse 80 
buttress thread, cortical transition region; VII = V thread, corti- 60 
cal transition region; VIII = square thread, cortical transition re- 40 
gion; IX = buttress thread, cancellous bone; X = reverse buttress
20 
thread, cancellous bone; XI = V thread, cancellous bone; XII =
0 
square thread, cancellous bone; XIII = buttress thread, cortical
I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI
bone; XIV = reverse buttress thread, cortical bone; XV = V thread,
cortical bone; XVI = square thread, cortical bone. c Region

Fig 8 (right)  Buccolingual cross section of compressive stress

distribution in the supporting bone around the implant with re-
verse buttress threads at 50% osseointegration.

DISCUSSION

The assigned transversely isotropic elastic proper-

ties adopted in this study (Table 1) were expected to
adequately approximate the behavior of anisotro-
pic bone. Calculated stresses with bone considered
nonisotropic might deviate from those for which the
bone is assumed to be isotropic.13 In an anisotropic
material, calculation of von Mises stresses is not ap-
propriate when studying failure, since the yield or
fracture condition is not generally independent of
hydrostatic pressure.25 However, the present study
did not consider failure or plastic deformation, so the

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Mosavar et al
Osseointegration
120  50% 75% 100%
100 
Stress (MPa)
80  0.025
60  0.02
40 
20  .005
0  0
I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI
Region
Fig 9  Maximum compressive stresses in the bone structure
for different degrees of osseointegration. See Fig 7 legend for
definitions of I through XVI.
von Mises equivalent stress was considered accept-
able as a comparative criterion.6,24,26,27 Moreover, the
considered stress components as well as the pressure
(hydrostatic stress) evaluation will inspire more confi-
dence in outcomes; these factors were not evaluated
in previous work.
As shown in Table 2, bone with a higher degree of
osseointegration must withstand higher stresses; yet
lower strains are caused. This result supports the claim
of Winter et al11 that an increase in the elastic modulus
of bone will lead to a reduction in micromovement.
This implies that an implant that is less than fully os-
seointegrated is more susceptible to failure. With
regard to clinical evidence of the degree of osseoin-
tegration for well-functioning implants,28,29 a range of
75% to 90% can be considered an appropriate range
for the present evaluation of different thread designs.
To determine the effect of variations in the thread
profile design upon the bone stresses, it was assumed
that all model parameters were identical, except the
thread shape. This made it possible to compare threads
with different shapes. For all models, both the stress
distribution pattern in jawbone and the displacement
trend of the implant-abutment complex were akin to
those shown in previous reports.4,30–32 This was also
the case for the von Mises stress distribution patterns
within the supporting structures, which were similar
in all four thread designs considered.4,32 This result is
similar to the predictions of Geng et al,3 who compared
different thread configurations for stepped-screw im-
plants. Their findings implied that the thread-form
configuration does not greatly affect stress distribution
patterns in cortical bone. Moreover, the results of the
present study are in accordance with those reported by
Hansson and Werke,33 who realized that the shape of
the thread profile has a profound effect upon the mag-
nitude of the stresses in the cortical bone.
A crucial factor in the outcome of implant treatment
(success or failure) is the manner in which stresses
1324 Volume 30, Number 6, 2015
© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Osseointegration
0.04  50% 75% 100%
0.035 
Displacement (mm)
0.03 
 
 
0.015 
0.01 
 
 
I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI
Region
Fig 10   Maximum amounts of displacement in the bone struc-
ture for different degrees of osseointegration. See Fig 7 legend
for definitions of I through XVI.
and occlusal forces are transferred to the peri-implant
bone.7 Implant threads should be designed to intensify
desirable stresses while minimizing the amount of un-
desirable stresses at the bone-implant interface. Three
types of loads are generated at the bone-implant in-
terface: compressive forces, tensile forces, and shear
forces.34 Studies have shown that compressive forces
have the most favorable effect on bone tissue and may
help to maintain bone.1 This type of force increases the
bone density and, hence, bone strength over time,16
while tensile and shear forces have been shown to re-
sult in weaker bone, with shear forces being the least
beneficial.34 Decreasing the shear load at the implant-
bone interface may result in greater transmission of
compressive loads, which is favorable. The type of
force generated depends on the implant shape. Hence,
an ideal implant design should provide a balance be-
tween compressive and tensile forces while minimizing
shear forces.
The square thread configuration showed the lowest
stresses for all degrees of osseointegration in the im-
plant-cortical bone transition region as the critical zone
for design purposes. However, buttress, V, and reverse
buttress configurations seemed to have roughly the
same stress values when 75% to 100% osseointegration
was simulated (Tables 2 and 3). This may point to the su-
periority of the square threads, because this design had
the least stress concentration when compared with oth-
er thread shapes.30 However, in a comparative study of
implants with 12 different thread shapes, including dif-
ferent kinds of buttress, reverse buttress, V, and square
configurations, Kong et al32 stated that there were ad-
vantages to each square thread, buttress thread, and V
thread design. On the other hand, they suggested that
all three reverse buttress designs were suitable configu-
rations for cylindric implants. This difference versus the
current results may arise from their assumptions of rigid
implant anchorage in the bone model along its entire
interface, as well as bone isotropy.

According to the shear stress diagrams shown in
Fig 7 and shear stress components in Table 3, when
different degrees of osseointegration were simulated,
the square thread configuration showed not only the
widest shear stress distribution within the jawbone but
also the lowest total shear stress in each case within the
transition regions. The buttress and V thread designs
seemed to be the next most favorable configurations,
sequentially, while the reverse buttress design was
least favorable. Misch et al34 reported the same advan-
tage for square threads versus V-shaped and reverse
buttress threads. Whereas in the current study all three
shear stress components were considered destructive
stresses, the detailed results are not completely in ac-
cordance with the predictions of previous studies, and
in some cases they even contradict them. It has been
claimed that V-shaped threads generate higher shear
stresses than reverse buttress threads do.34 Although in
this study this theory was supported in the bulk regions
of cortical and cancellous bone, especially with higher
degrees of osseointegration, it was refuted within tran-
sition regions. This contradiction may also be caused
by the modeling assumptions made by Misch et al,
particularly regarding 100% osseointegration and iso-
tropic bone properties.
With respect to compressive stresses (Fig 9), at first
glance, the best configuration would appear to be the
reverse buttress design, which induces the highest
stresses in the transition region. For this reason, some
studies mention it as the most advantageous design, as
it leads to more compressive stresses than other thread
designs (buttress, V, square).4 The present study sup-
ports the findings of Eraslan and Inan4; nevertheless,
the differences in stress values among reverse buttress,
V, and square thread designs were relatively small. In
addition, the higher compressive stresses induced by
square threads in cortical bone outside the transition
region may be a consequence of better stress distri-
bution. This corresponds with reports that compres-
sive stresses around implants with square threads
were more evenly distributed than those around im-
plants with V threads.1,30 Also, it is remarkable that
the compressive stresses within cancellous bone were
negligible.
Immediate loading increases patient satisfaction.
Previous works showed that several factors influence
the results of immediate implant loading, among which
primary stability is one of the most important factors.35
The principal gateway to stability for immediately load-
ed implants in the early period is mechanical interlock-
ing rather than osseointegration.17 With respect to the
implant displacement and thereby strains seen within
the different models (Fig 10), the square threads again
showed the best results. This model had the least dis-
placement and thus the least strain in all cases, which
© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Mosavar et al
might mean that square threads provide better me-
chanical stability than other thread shapes. Moreover,
since Abuhussein et al16 indicated that implant threads
should allow for better stability and more implant sur-
face area, among the tested thread designs, the square
threads will lead to the highest degree of bone-to-im-
plant contact since they have the greatest perimeter in
a section. In an animal study, Steigenga et al36 implied
this, too, and added that implants with square threads
showed higher removal torque than implants with V-
shaped and reverse buttress threads. Also, it appears
and is assumed that implants with square threads will
have better primary stability. This could be examined
in future studies.
Consequently, since the aim of this study was to
evaluate different basic thread designs, based on the
findings discussed, it seems that the square thread
design should be perceived as the best basic configu-
ration for threaded implants. It will remain a point of
interest for manufacturers to develop implant thread
designs, and it should be a factor for clinicians to con-
sider when planning treatment and choosing implants.
However, the basic square thread profile may be modi-
fied by some minor changes; for instance, Chun et
al30 reported that square threads filleted with a small
radius—on the upper intersection edge of thread
and implant inner diameter—were more effective in
distributing stresses than square threads, V threads,
plateau-type threads, and plateau-type threads with a
small radius of curvature.
Finally, it should be noted that laboratory models
were merely simulated in this work. Moreover, al-
though transversely isotropic bone was implement-
ed, the bone was nevertheless modeled as a linearly
elastic continuum. These might represent limitations
in interpreting the current findings for a functioning
biologic environment, and further investigation is
required.
CONCLUSIONS
This study proposed a computational model in which
bone anisotropy and partial osseointegration condi-
tions were taken into account. Finite element analyses
confirmed that different implant thread forms and vari-
ous degrees of osseointegration did not significantly
affect stress distribution patterns in the supporting
bone structure. Additionally, cortical bone and the
bone structure adjacent to the first thread bore higher
von Mises, compressive, and shear stresses than the
cancellous bone did. Moreover, in almost all the mod-
els, the von Mises stresses gradually increased in the
supporting structures with an increase in the degree of
osseointegration.
The International Journal of Oral & Maxillofacial Implants 1325
Mosavar et al
On the other hand, within the limitations of the
study, it was also seen that an implant with square
threads is an optimal configuration because of the de-
sirable amounts of von Mises, compressive, and various
shear stresses seen around it, as well as its minimal dis-
placement under stress.
ACKNOWLEDGMENTS
The authors reported no conflicts of interest related to this study.
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