Abstract
The aim of this study was to evaluate the stress distribution of monocortical and bicortical implant placement of external hexagon connection in the anterior region of the maxilla by 3D finite element analysis (FEA). 3D models were simulated to represent a bone block of anterior region of the maxilla containing an implant (4.0 × 10.0 mm) and an implant-supported cemented metalloceramic crown of the central incisor. Different techniques were tested (monocortical, bicortical, and bicortical associated with nasal floor elevation). FEA was performed in FEMAP/NeiNastran software using loads of 178 N at 0°, 30°, and 60° in relation to implant long axis. The von Mises, maximum principal stress, and displacement maps were plotted for evaluation. Similar stress patterns were observed for all models. Oblique loads increased the stress concentration on fixation screws and in the cervical area of the implants and bone around them. Bicortical technique showed less movement tendency in the implant and its components. Cortical bone of apical region showed increase of stress concentration for bicortical techniques. Within the limitations of this study, oblique loading increased the stress concentrations for all techniques. Moreover, bicortical techniques showed the best biomechanical behavior compared with monocortical technique in the anterior maxillary area.
Highlights
Adequate primary stability of osseointegrated implants is considered one of the most important rules for the success of rehabilitation using dental implants [1, 2]
There is no consensus if this increase of primary stability could reduce the stress distribution on bone tissue
Consider that bicorticalization increases significantly the removal torque as compared to that of monocortical anchorage of implants [2]; there is an improvement of biomechanical stability using bicortical technique [22]
Summary
Adequate primary stability of osseointegrated implants is considered one of the most important rules for the success of rehabilitation using dental implants [1, 2]. Bicorticalization was used to improve the stability of implant on the bone tissue for anterior and in the posterior region of the maxilla [3], mainly for immediate loading procedures [2]. There is no consensus if this increase of primary stability could reduce the stress distribution on bone tissue. Researches indicate higher stress and strain concentrations in low-quality bone tissue [5, 6]. In this bone type, in upper jaw, bicorticalization placement of the implant could allow the use of a longer implant, improving the stress and strain distribution. Some studies indicate probable bone atrophy by disuse on medium region of the implant due to increase of stress concentration
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