1
Mechanical characterization of surgical templates
used for guided dental implant placement
Narayanan Kakkad, Katrien Baeck and Jos Vander Sloten

Abstract— This study evaluated the mechanical strength
characteristics of surgical templates used for guided dental
implant placement, based on the location, angle of drill and
materials. The template was evaluated using both theoretical
calculations based on analytical formulas and finite element
analysis. The template was evaluated for different loading cases
and procedures. A detailed mesh convergence analysis was
performed to determine the optimal mesh. Four different cases
were studied comprehensively. The results showed that the
maximum stresses produced in the templates for each of the cases
for the two surgical procedures; drilling and implant insertion
were lower than the flexural strength of the material (95MPa). The
current material used for production was found to be superior to
the other two available biomaterials used for template production.
The change in inclination of drill did not have any major impact
on the stress produced in the template during drilling procedure.
Thus the current design used for template production was
determined to be safe in the cases studied under the loads applied.
Index Terms—Guided dental implant placement, Surgical
template, Nobel Biocare, Beam theory, Mesh convergence
analysis, Finite element analysis.
I. INTRODUCTION
R ECENTLY the conventional two staged treatment procedure
for dental implant placement has been replaced by
immediate loading of implants using guided implant placement
techniques [1] . Clinicians use computer aided surgical planning
tools provided by Nobel Biocare to determine the patient
pathology and to come up with a surgical plan and also decide
the optimal implant placement [2].
Finally the surgical planning data is translated into the
operating room through aid of surgical templates which have
metallic sleeves for guiding the drilling and implant insertion
procedures [3]. The templates have been used extensively in
recent past. However, there has been no comprehensive study
performed to determine the mechanical strength characteristics
of these surgical templates.
The objective of the present study was therefore to evaluate
the mechanical strength characteristics of surgical templates
used for guided dental implant placement, based on the
location, angle of drilling and materials.
II. THEORETICAL CALCULATIONS
There were four different partially edentulous cases chosen
for study (Fig. 1). For each of these cases, the drilling procedure
and the implant insertion procedures were separately studied.
Initially the study involved application of beam theory using
various analytical formulae to determine the stresses involved
in each case.
Fig. 1 - (a) Case 1; (b) Case 2; (c) Case 3; (d) Case 4. The red circle indicate
the loading position.
A. Assumptions
In order to adapt the loading cases to beam theory, several
assumptions were made, which are listed below:
1. The template is assumed to be a beam of uniform
rectangular cross section, the dimensions of the rectangular
cross section are as given below. The template is made out of
Renshape, for which young’s modulus, E= 2500MPa [5].
2. Breadth, b = 10mm.
3. Depth, d = 2.5mm (template thickness=2.5mm) [3].
4. Moment of Inertia, I = bd3/12 = 13.02mm4.
5. Section Modulus, Z = bd2/6 = 10.41mm3.
6. Supports are assumed to be the sharp edges of the tooth.
7. The original template has metallic sleeves and drill guides
supporting the drilling and implants insertion steps. This makes
template a composite beam. Since this would make the
calculations too complex which is not possible using analytical
solutions, the metallic sleeves and drill guides are not taken into
consideration.
8. Thus, the entire load is assumed to be taken by the acrylic
part of the template.
9. For the drilling procedure a load of 100 N was used as the
maximum force acting on the template [4].
10. For the implant insertion procedure, it was assumed that,
the clinician would make an extra half turn of the implant
resulting in a deflection of the template by a distance half the
pitch [3] of the implant thread (0.375mm).
B. Calculations
Each of the cases discussed previously were simplified so as
to apply analytical equations of beam theory. The simplified
models for each of the cases have been depicted in the Fig. 2.
For determining the maximum stress during drilling procedure,
in case1-4 the equations (1), (2), (3) and (4) respectively were
used [6].

𝑊𝑎𝑏
𝑠𝑚𝑎𝑥 = −
𝑍𝑙
𝑊𝑙
𝑠𝑚𝑎𝑥 = −
4𝑍
𝑊𝑐
𝑠𝑚𝑎𝑥 =
𝑍
𝑊𝑐
𝑠𝑚𝑎𝑥 =
𝑍
where, smax is the resulting maximum stress produced in the
template, W the load of 100 N, a, b, c and l are dimensions
related to the beam length and point of action of load with
respect to the supports of the beam and Z is the section modulus
which has already been defined.
For determining the maximum stress during implant
insertion procedure as well, for case 1-4 the equations (1), (2),
(3) and (4) respectively were used. In each of those cases the
load W was determined from the equation of deflection using
the equations (5), (6), (7) and (8) respectively [6].
𝑦𝑚𝑎𝑥 = 𝑊𝑎2 𝑏 2 /3𝐸𝐼𝑙
𝑦𝑚𝑎𝑥 = 𝑊𝑙 3 /48𝐸𝐼
𝑦𝑚𝑎𝑥 = 𝑊𝑐 2 (𝑐 + 𝑙)/3𝐸𝐼
𝑦𝑚𝑎𝑥 = 𝑊𝑐 2 (𝑐 + 𝑙)/3𝐸𝐼
Where, ymax is the resulting maximum deflection due to the extra
half turn of the implant (0.375mm), W the resulting load and E
the young’s modulus of the material. Thus using these
equations the corresponding loads produced for each case was
determined.
Fig. 2 – Beam theory applied to every case. (a) Case 1; (b) Case 2; (c) Case 3
and Case 4.
III. FINITE ELEMENT MODELLING
The finite element modelling and analysis was performed in
an Intel Xeon CPU E5-2600 with a clock speed of 2.20GHz,
with a RAM of 32GB and 64-bit operating system. In this study
the meshing tool in use is ANSA (version: 15.2.3). ANSA is a
meshing software which is capable of creating mesh of high
quality from an STL file and create an input file for Abaqus
software. The FE calculations have been performed using the
Abaqus 6.13 software package.
A. Material properties and interactions
The cast in the current analysis has been assumed to be a rigid
2
(1) body as the cast will undergo no deformation compared to the
template. In this study, four-node, first-order, one integration
(2) point tetrahedral elements of type C3D4 were used [7]. A
rigorous mesh-sensitivity study was carried out to obtain a
(3) computationally accurate finite-element mesh. In the current
model, we are interested in determining the stress developed in
(4) the template for each of procedures [8] [9]. Thus, the history of
the stress-time signal is used as the criterion of convergence.
All the results are presented based on simulations performed
with an optimized mesh. Renshape is the material used to
produce templates at Nobel Biocare. Thus a young’s modulus
of 2500MPa and Poisson’s ratio of 0.3 was defined for the
template.
In this model it is very difficult to define a separate part with
properties of the sleeve and then to define a surface to surface
interaction between the template and the sleeve, as the two parts
in real are glued to each other. Due to the complex nature of
interaction between the two parts this has been avoided and
(5)
instead the nodes inside the drill hole of the template were
(6) selected and constrained as a rigid body using tie nodes.
A surface to surface contact was defined between the two
(7) interacting surfaces. The cast was defined to be the master and
(8) template the slave surface as cast is a rigid body [10]. Finite
sliding algorithm has been implemented as recommended for
static analysis. A tangential behavior has been defined between
the two surfaces with a friction coefficient of 0.3 [11]. Similarly
a normal behavior of hard contact has been defined.
Fig. 3 – Loading in every case. (a) Case 1; (b) Case 2; (c) Case 3; (d) Case 4.
The pink colored loads represent the clinician and anchor load and the orange
colored load represents the drilling load.
B. Boundary conditions and loads
The cast, earlier constrained to be a rigid body, was fixed on
all of its degrees of freedom. The major loads applied were the
clinician load, anchor load, drilling load and implant insertion
load (Fig. 3). The clinician load of 25N was applied which
represents the force with which the clinician presses the
template using his/her fingers [12]. An anchor load of 25N was
applied, which is normally achieved using the anchor pins
which stabilizes the template. For the drilling step a drill load
of 100N was applied [4]. For implant insertion a displacement
 3

boundary condition was applied on the sleeve of 0.35mm [3]. of angle the applied load makes with the face of the drilling
guide to see its effects on the maximum stress resulting in each
IV. RESULTS case and to come up with a comparison [15]. Even though there
For all the four cases, results were obtained using theoretical was a slight degree of increase in the stress, from the results it
as well as finite element analysis. The results from the was clear that the increase was not significant. So, the effect of
theoretical calculations are listed in the Table I. From the results the angle of inclination of the applied load is not of a big issue.
it can be inferred that the template would remain safe under More importantly the maximum stresses produced are all within
most of the cases except for the drilling procedure in case-4, the safe limits and the template is safe in all cases.
TABLE I
RESULTS FROM THEORETICAL CALCULATIONS
Smax Smax
Case
Drilling (MPa) Implant insertion(MPa)

Case-1 48.4 27.2

Case-2 48.03 35.18
Case-3 48.03 46.9
Case-4 144.09 9.4

since the stress is above the ultimate flexural strength of the

material (95MPa) [5].
Finite element analysis was performed for each of the four
cases for the two procedures under study. Both quantitative and
qualitative results were determined. For quantitative results
extraction, python scripting in Abaqus was performed. The
results have been quantified in Table II, Fig. 4 and Fig. 5. The
TABLE II
RESULTS FROM FINITE ELEMENT ANALYSIS
Smax Smax
Case Fig. 5 – Implant insertion results (MPa). (a) Case 1; (b) Case 2; (c) Case 3; (d)
Drilling (MPa) Implant insertion(MPa)
Case 4.

Case-1
A study was also performed to compare the results with
41.4 8.32
Case-2 different materials. In this study, the case-1 was used with a
56.7 32.2
Case-3 32.3 2.09 different material property in each case. The two materials with
Case-4 44.63 2.09 which the current design was compared were- Accura
ClearVueTM [16] and DS 3000 [17]. When compared to the
other two materials used in the industry Renshape was found to
maximum stresses were determined in a region of interest,
be superior in its performance from the results obtained as
which was defined close to the vicinity of the applied load.
maximum stress produced in both cases were close to the value
obtained with Renshape, but the flexural strength of both the
materials were low as compared to Renshape [5].

V. DISCUSSION
There was no previous work related to study of mechanical
strength characteristics of surgical templates found in the
literature review. Due to the lack of previous work in this field
a new methodology had to be defined. Previous studies in the
field of determining drill force was used as a reference in the
present study. For the implant insertion step it was assumed that
an extra half rotation of the implant would be made by the
clinician.
As far as the theoretical calculations are concerned, beam
theory was applied to these situations. The template was the
beam and the drilling and implant insertion loads were assumed
to be acting as point loads over the template. A lot of
assumptions were made to simplify the complex loading
scenario, to apply beam theory. Thus the results obtained from
Fig. 4 – Drilling results (MPa). (a) Case 1; (b) Case 2; (c) Case 3; (d) Case 4.
these analytical equations were far from the real results. Even
A study using the case-1 was performed to study the effect
then these results would show a general trend.

A Finite Element study was performed as well. A mesh
convergence was performed to determine the optimal mesh size
[13] [14]. The model was assumed to be a static model. Since
it’s a static model the maximum load during drilling and
implant insertion is applied in on single step, but using a ramp.
Since a surface to surface contact definition has been applied
with a tangential behavior defined, some non-linearities are
expected in the model [10]. Therefore accordingly the
incrementation of the step module needs to be controlled.
The model used constrains to define the steel sleeves inserted
as guides for the drills. For future models a proper sleeve should
be modelled with an interaction defined between the sleeve and
the template. The cast was fixed at all its degrees of freedom.
The template was loaded using pressure load, where the load
would be applied at angle of 90 degrees to the drill surface. This
case would be an ideal case. In real life some minor deviation
from this is expected. Thus a study with different angles were
also performed, giving an idea of how a change in angle would
affect the stresses developed in the template. It was found that
though there is a correlation between the two, it is not a critical
factor as the variation in the stress with every 1 degree change
in angle was estimated to be around 0.1MPa.
The results obtained from the simulations showed that, the
templates would remain safe under the applied loads and
boundary conditions. The drilling and implant insertion process
invariably resulted in a maximum stress which was less than
ultimate flexural strength of the material. In most of the cases
this was less than half the strength of the material. In both the
procedures, case 2 showed highest maximum stress values. The
stress produced due to drilling increased with an increase in
distance from the support in case 3 and 4. For implant insertion
though with the same displacement the stress decreased with an
increase in distance from the nearest support. The study with
two other materials (Accura ClearVueTM and DS3000) used in
the market was also performed. The results from that study also
validated that, the current material is superior in its mechanical
strength characteristics.
Thus the finite element model created provides a very robust
and dependable option which takes into account all possible
complexities if the real life case. Though some assumptions
have been made, they are taken with due consideration. The
present work provides a good model for reference for any future
work in this field.
4
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