Influence of Implant Design on the Biomechanical

Environment of Immediately Placed Implants:

Computed Tomography–Based Nonlinear
Three-Dimensional Finite Element Analysis
Roberto S. Pessoa, DDS, MS, PhD1/Paulo G. Coelho, DDS, PhD2/Luiza Muraru, MS, PhD3/
Elcio Marcantonio Jr, DDS, MS, PhD4/Luis Geraldo Vaz, MS, PhD5/
Jos Vander Sloten, MS, PhD6/Siegfried V. N. Jaecques, MS, PhD7

Purpose: To evaluate the influence of different implant designs on the biomechanical environment of
immediately placed implants. Materials and Methods: Computed tomography (CT)­–based finite element models
comprising a maxillary central incisor socket and four commercially available internal-connection implants
(SIN SW, 3i Certain, Nobel Replace, and ITI Standard) of comparable diameters and lengths were constructed.
Biomechanical scenarios of immediate placement, immediate loading, and delayed loading protocols were
simulated. Analysis of variance at the 95% confidence level was used to evaluate peak equivalent strain
(EQV strain) in bone and bone-to-implant relative displacement. Results: Loading magnitude (77.6%) and the
clinical situation (15.0%) (ie, presence or absence of an extraction socket defect, condition of the bone-to-implant
interface) presented the highest relative contributions to the results. Implant design contributed significantly
to strains and displacements in the immediate placement protocol. Whereas a greater contribution of implant
design was observed for strain values and distributions for immediately placed and immediately loaded
protocols, a smaller contribution was observed in the delayed loading scenario. Conclusion: Implant design
contributes significantly to changing biomechanical scenarios for immediately placed implants. The results also
suggest that avoiding implant overloading and ensuring high primary implant stability are critical in encouraging
the load-bearing capability of immediately placed implants. Int J Oral Maxillofac Implants 2011;26:1279–1287

Key words: dental implant design, finite element analysis, immediate implant loading, immediate implant
placement

1Researcher, Department of Diagnostic and Surgery, Division of

Periodontics, UNESP, São Paulo State University, Araraquara,
I n the conventional delayed loading implant protocol,
a certain period of undisturbed healing is suggested
for successful implant osseointegration.1–3 Although
Brazil.
2Professor, Department of Biomaterials and Biomimetics, New this approach has been proven to be highly predict-
York University, New York, New York. able and successful, the extended treatment period
3Researcher, MOBILAB, Health Care and Chemistry
may be perceived as a considerable inconvenience for
Department, University College, Kempen, Belgium. patients desiring rapid rehabilitation, especially when
4Professor, Department of Diagnostic and Surgery, Division of

Periodontics, UNESP, São Paulo State University, Araraquara,

Brazil.
5Professor, Department of Dental Materials and
Prosthodontics, Division of Dental Materials, UNESP, São
Paulo State University, Araraquara, Brazil.
6 Professor, Division of Biomechanics and Engineering Design,
the anterior region is considered.4–6 Thus, consider-
able effort has been directed toward immediate load-
ing of dental implants. In some situations, the implants
may even be placed in fresh extraction sockets, with
the goal of reducing the time between tooth extrac-

Catholic University of Leuven, Leuven, Belgium.

7Researcher, Leuven Medical Technology Centre, Leuven,
Belgium; Division of Biomechanics and Engineering Design,
Catholic University of Leuven, Leuven, Belgium.
Correspondence to: Dr Roberto S. Pessoa, UNESP, Faculdade
de Odontologia, Departamento de Diagnóstico e Cirurgia, Rua
Humaitá 1680, Sala 218, Cep: 14802-550, Araraquara, São
Paulo, Brasil. Fax: +55-16-3301-6406. Email: rp@inpes.com.br
tion and delivery of the definitive prosthesis.
Despite reports of promising results in experimental
and clinical studies of immediate loading protocols,7–11
failures can still occur and have been suggested to
arise from biomechanical factors. For instance, adverse
forces exerted on the implant-supported prostheses
may induce micromovement beyond 150 µm during
healing, potentially leading to fibrous encapsulation

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Pessoa et al
A B C D
of the implants.12–15 Even for implants that have al-
ready osseointegrated, excessive loading causes peri-
implant bone loss and possible treatment failure,16–18
as strain levels exceeding the physiologic tolerance
threshold of bone around the implant (above 4,000 µε)
may cause microdamage to accumulate and induce
bone resorption.19,20
Several factors are recognized as influencing the
transmission of loads to implants and bone, such as
bone quality in the insertion area; the nature of the
bone-to-implant interface; the material properties of
the implants and prosthesis; the surface roughness of
the implant; the occlusal condition (ie, magnitude, di-
rection, and frequency of loading); and the design of
the implant.21–26 Thus, to increase the predictability of
a variation to the standard implant placement and res-
toration protocol, investigations concerning the effect
of different implant designs and clinical scenarios on
primary stability of implants are desirable.27
The influence of various implant design features has
been investigated mainly with delayed loading sce-
narios, whereas a few studies have addressed imme-
diate loading approaches.28–30 Moreover, insufficient
data are available on many outcome parameters for
implants immediately loaded after placement in fresh
extraction sockets.31
Regarding the influence of implant design on im-
mediately placed implant biomechanical scenarios,
previous studies using computer simulations have
addressed the effects of implant-abutment connec-
tion type and platform switching.24,25 These finite ele-
ment analyses (FEA) showed that different abutment
connections and/or platform switching did not signifi-
cantly influence the bone-to-implant relative displace-
ment and peak strain in the bone around an implant
that was immediately placed and loaded. While initial
developments have shown that the implant connec-
tion did not have an effect on the bone biomechanical
scenario in the immediately placed protocol, investi-
gations concerning the effect of other implant design
variables are desirable.
The objective of the present study was to evaluate
the influence of different implant designs on the bio-
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Fig 1   Implant, abutment, and abutment
screw meshes; (A) SIN SW, (B) 3i Certain,
(C) ITI Standard, (D) Nobel Replace.
mechanical environment of peri-implant bone under
immediately placed, immediately loaded, and delayed
loading clinical situations.
MATERIALS AND METHODS
An in-depth description of the methods applied to ob-
tain the individualized finite element models used in
the present study was reported earlier.24,25 Briefly, the
computed tomographic (CT) scans of a maxillary central
incisor extraction socket obtained from a dry maxilla
were reconstructed into a three-dimensional solid
model by thresholding within an image-processing
software program (Mimics 9.11, Materialise).
Computer-aided design solid models of the im-
plants and prosthetic components were obtained by
reverse engineering to resemble four commercially
available implants: a 4.5- × 13-mm SIN SW implant
(SIN Sistema de Implante), a 4.1- × 13-mm 3i Certain
implant (Biomet/3i), a 4.3- × 13-mm Nobel Replace im-
plant (Nobel Biocare), and a 4.1- × 12-mm RN synOcta
ITI Standard implant (Institut Straumann). The implant
dimensions were selected to be comparable in size,
and all the implants featured internal connections. The
implants were imported into the Mimics software and
positioned 1 mm deep inside the extraction socket, in a
central position and a palatal direction.31 The abutment
and abutment screw models were subsequently aligned
to the implants following the instructions of the implant
manufacturers. All the abutments were 10 mm in height
from the implant shoulder. The implant insertion hole in
the extraction socket solid model was obtained by Bool-
ean subtraction between the bone and implant solids.
Bone, implant, abutments, and abutment screw
models were meshed separately in MSC.Patran 2005r2
(MSC.Software) (Fig 1). No simplifications were made
to the macrogeometry of any implant system design
(ie, truly spiral threads). In addition, the bone mesh was
tested for convergence.24,25 The smallest elements in
the constructed tetrahedral meshes were about 50 µm.
Different levels of mesh refinement were used to rec-
ognize different features (eg, at the threads).
 Pessoa et al

Table 1   Mechanical Properties of Bone, Table 2   Peak Equivalent Strain (EQV Strain)
Implants, and Prosthetic Materials Used in the Bone and Bone-to-Implant Relative
Material Young’s modulus Poisson ratio Displacement for All Simulated Models
Titanium 110,000 0.33 Implant/clinical Amount of Bone EQV Displacement
situation loading strain (με) (µm)
Cortical bone 13,700 0.30
SIN
Trabecular bone 1,370 0.30
Immediate 50 N 2,873.3 7.6
placement 100 N 5,982.0 15.3
200 N 10,022.2 30.1
Immediate 50 N 1,720.1 1.7
loading 100 N 4,543.0 3.2
200 N 9,587.3 6.4
The gray values of the CT images were used to as- Delayed loading 50 N 1,329.0 –
sign the material properties of the elements contained 100 N 2,978.3 –
in cortical and trabecular bone.32 The Young’s moduli 200 N 6,010.4 –
and Poisson ratios for the materials used in the present 3i Certain
study are summarized in Table 1.33 Immediate 50 N 3,459.9 10.1
Frictional contact elements were used to simulate placement 100 N 6,940.8 20.5
the bone-to-implant interface in the immediately 200 N 10,945.3 42.1
placed and immediately loaded implant models (fric- Immediate 50 N 1,804.5 1.4
tional coefficient µ = 0.3)28 as well as the implant sys- loading 100 N 5,163.3 2.8
200 N 7,382.2 5.6
tem component interfaces in contact (µ = 0.5).34 In
addition, socket healing was simulated in the immedi- Delayed loading 50 N 1,802.6 –
100 N 3,449.8 –
ate loading and delayed loading models by modeling
200 N 7,382.2 –
a hard tissue bridge at the alveolar ridge region. For
Nobel Replace
the delayed loading model (ie, loading applied after
implant osseointegration), the bone-to-implant inter- Immediate 50 N 2,732.4 5.5
placement 100 N 5,672.1 10.0
face was assumed to be glued. 200 N 11,044.1 22.3
In three loading situations, forces of 50 N, 100 N,
Immediate 50 N 1,752.9 1.5
and 200 N were applied with 45 degrees of inclination loading 100 N 3,260.0 3.1
with respect to the long axis of the implant in a palato- 200 N 6,599.4 6.3
buccal direction on the top of the abutment’s central Delayed loading 50 N 1,580.5 –
region.35 All models were fully constrained in all direc- 100 N 3,159.7 –
tions at the nodes on the mesial and distal borders. 200 N 6,330.9 –
The FEA and postprocessing were accomplished by ITI synOcta
means of MSC.MARC/Mentat 2005r3 software (MSC. Immediate 50 N 2,582.8 14.5
Software). The results from the 36 models for the peak placement 100 N 5,196.5 29.3
equivalent strain (EQV strain) in the bone and the 200 N 10,659.8 59.5
bone-to-implant relative displacement were inter- Immediate 50 N 1,618.6 2.2
preted by means of a general linear model analysis of loading 100 N 3,231.3 4.5
200 N 6,082.4 9.1
variance (ANOVA) (SAS/STAT statistical software, ver-
sion 9.1, SAS Institute) at a 95% level of confidence.36 Delayed loading 50 N 1,540.5 –
100 N 3,032.9 –
Implant design, loading magnitude, and clinical situ-
200 N 6,082.4 –
ation (immediately placed, immediately loaded, and
delayed loaded implants) were used as independent
variables, and EQV strain and bone-to-implant dis-
placement were considered the dependent variables.

RESULTS

Table 2 shows the EQV strain in the bone and the bone- the values for EQV strain and bone-to-implant relative
to-implant relative displacement for the four different displacement. In general, the highest values for strains
implant models. The different design characteristics of and displacements were found in the immediate place-
the implants resulted in nonnegligible differences in ment simulations. In this clinical situation, the 3i Certain

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Pessoa et al

Table 3   Analysis of Variance for the Peak EQV in Bone

Parameter DF SS MS P Contribution (%)
Implant Design 3 8,239,676.6 2,746,558.9 .0143* 2.57
Clinical Situation 2 48,328,401.0 24,164,200.5 <.0001* 15.07
Implant Design × Clinical Situation 6 4,672,145.9 778,691.0 .2538 1.46
Loading Magnitude 2 248,902,526.1 124,451,263.0 <.0001* 77.63
Implant Design × Loading Magnitude 6 2,231,006.5 371,834.4 .6389 0.70
Clinical Situation × Loading Magnitude 4 8,246,935.8 2,061,734.0 .0272* 2.57
*P < .05 (statistically significant).
DF = degrees of freedom; SS = sum of squares; MS = mean square.

Table 4   Analysis of Variance for the Relative Displacement Between implant and Bone
Parameter DF SS MS P Contribution (%)
Implant Design 3 458.9 152.9 .0122* 9.65
Clinical Situation 1 1,998.4 1,998.4 <.0001* 42.00
Implant Design × Clinical Situation 3 347.5 115.8 .0233* 7.30
Loading Magnitude 2 1,220.4 610.2 .0005* 25.65
Implant Design × Loading Magnitude 6 135.4 22.6 .3700 2.85
Clinical Situation × Loading Magnitude 2 597.2 298.6 .0031* 12.55
*P < .05 (statistically significant).
DF = degrees of freedom; SS = sum of squares; MS = mean square.

Table 5   Analysis of Variance for the Peak EQV in the Bone for a 50 to 100 N of Loading
Clinical Situation/Parameter DF SS MS Contribution (%)
Immediately placed
Implant Design 3 1,874,585.7 624862.0 9.1
Loading Magnitude 1 18,431,556.1 18,431,556.1 89.9
Implant Desing × Loading Magnitude 3 195,416.0 65138.7 1.0
Immediately loaded
Implant Design 3 1,548,804.97 516,268.32 11.4
Loading Magnitude 1 10,814,737.78 10,814,737.78 79.5
Implant Design × Loading Magnitude 3 1,246,488.99 415,496.33 9.2
Delayed loaded
Implant Design 3 237,829.7 79276.6 4.5
Loading Magnitude 1 5,069,087.2 5,069,087.2 95.37
Implant Design × Loading Magnitude 3 8207.2 2735.7 0.15
Saturated experimental design; no P values reported. DF = degrees of freedom; SS = sum of squares; MS = mean square.

design induced the highest EQV strain in the bone. The
SIN and Nobel Replace models induced intermediate
values, and the ITI Standard showed the lowest strain
levels. On the other hand, the ITI models presented the
highest relative displacements, followed by 3i and SIN.
The lowest bone-to-implant relative displacements
were observed for the Nobel models (Table 2).
Compared to the immediate placement scenario,
smaller variations in EQV strain and bone-to-implant
displacement between the different implant designs
were observed in the immediate loading and delayed
loading simulations. Similar trends between implant
systems’ influence on EQV strain and bone-to-implant
displacement were observed when immediate loading
and delayed loading protocols were compared to the
immediate placement situation (Table 2).
The results of ANOVA demonstrating the relative con-
tributions of implant design, clinical situation, and loading
magnitude on the peak EQV strain and bone-to-implant
relative displacement are presented in Tables 3 and 4, re-
spectively. In general, when all models were considered
together, the loading magnitude and the clinical situa-
tion provided the highest contributions to the depen-
dent variables (Table 3). However, Tables 3 and 4 show
that implant design also significantly influenced both
EQV strain and bone-to-implant relative displacement.

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 Pessoa et al

Table 6   Analysis of Variance for the Relative Displacement Between implant and Bone for a
50 to 100 N Loading
Clinical Situation/Parameter DF SS MS Contribution (%)
Immediately placed
Implant Design 3 219.3 73.1 51.89
Loading Magnitude 1 174.8 174.8 41.37
Implant Design × Loading Magnitude 3 28.5 9.5 6.75
Immediately loaded
Implant Design 3 1.8 0.6 23.28
Loading Magnitude 1 5.8 5.8 73.54
Implant Design × Loading Magnitude 3 0.3 0.1 3.18
Saturated experimental design; no P values reported. DF = degrees of freedom; SS = sum of squares; MS = mean square.

Immediately Immediately Osseo- Immediately Immediately Osseo-

placed loaded integrated placed loaded integrated

SIN SIN

3i 3i

Nobel Nobel

ITI ITI

100 2,000 4,000 100 2,000 4,000

EQV strain (µε) EQV strain (µε)

Fig 2   Occlusal view of EQV strain (µε) distribution in bone for Fig 3   EQV strain (µε) distribution for the SIN, 3i, Nobel, and
the SIN, 3i, Nobel, and ITI implants under a force of 100 N. ITI implants under a force of 100 N in the median buccopalatal
plane.

Tables 5 and 6 show the relative contribution of
clinical situation, along with implant design, loading
magnitude, and implant design × loading magnitude,
for EQV strain and bone-to-implant relative displace-
ment. Because the differences between the implant
designs were subtle in the 50- to 200-N loading range,
the results of 200-N loaded models are not presented
in Tables 5 and 6. With respect to the influence of the
implant design on the EQV strain for the different
­implant protocols (Table 5), the highest contribution
of the varying implant designs was seen for the im-
mediate loading models, followed by the immediate
placement situations. For the delayed loading models,
a twofold lower influence of the implant design was
observed.
Regarding the bone-to-implant relative displace-
ment in the immediate placement simulations, the con-
tribution of the implant design was more pronounced
than the contribution of a loading magnitude ranging
between 50 and 100 N and was two times higher than
the influence observed for the immediately loaded
models (Table 6).
The strain distributions for the SIN, 3i, Nobel, and
ITI 100-N loaded models are presented in Figs 2 and 3
in occlusal and buccopalatal plane views, respective-
ly. The strain scale was set to range between 100 and

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Pessoa et al
4,000 µε.19,20 The design characteristics of the implants
resulted in comparable strain distributions, indepen-
dent of the simulated clinical situation. Only small dif-
ferences were noted. One common observation was
that the highest strain concentration was located at
the buccal aspect of the implants in immediate place-
ment simulations, regardless of the implant design. In
this clinical situation, strain concentrations were also
noted in the apex of the implants, mainly for the SIN and
Nobel designs. The ITI implant presented a biomechani-
cally preferable strain distribution in the immediate
placement protocol, although a slightly higher volume
of bone with strains above 4,000 µε was observed for
this design, as was also observed for the 3i models. For
all designs, in immediate and delayed loading simula-
tions, the strains were concentrated mainly in the coro-
nal region of the implants, although some high strains
were also seen along the implant body in the immediate
loading protocol. The lowest strain levels were seen for
the delayed loading models. The most favorable strain
distribution in this clinical situation was seen for ITI and
SIN implants, followed by the Nobel models. A slightly
higher strain concentration was found for the 3i models.
DISCUSSION
Implant design has been suggested to affect the treat-
ment outcomes of osseointegrated implants, and its
effect on different clinical scenarios is yet to be deter-
mined, particularly in challenging situations such as im-
mediate placement and/or loading. In a recent literature
review, Quirynen et al31 found insufficient data on many
outcome parameters for immediately placed implants
and also suggested a tendency toward a higher risk of
implant loss when implants are immediately loaded in
fresh extraction sockets. They also r­ ecommended more
studies of variations in implant designs and their effect
on immediate implant placement.31
In a prospective multicenter clinical study, Donati et
al11 reported significant differences on the frequency of
implant loss and the amount of bone loss for different
implant designs when immediately loaded in a single-
tooth replacement scenario in the anterior mandible and
maxilla, leading to the rationale for the present study. In
agreement with their study, the present results showed
that implant design did make a significant contribution to
the biomechanical environment of immediately placed
and loaded implants. However, loading magnitude and
clinical situation (ie, presence or absence of an extraction
socket defect, condition of the bone-to-implant interface)
made more dramatic contributions to the strains and dis-
placements in this clinical situation. In fact, implant design
was even more relevant to the relative bone-to-implant
displacement (which is a measure of implant stability)24,25
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in the immediate placement models than a loading mag-
nitude ranging between 50 and 100 N.
For all immediate loading situations, primary im-
plant stability, allowing little micromovement in bone,
is essential for the uneventful formation of bone tissue
at the bone-implant interface.37–41 ­Vandamme et al,23
in a bone chamber experiment, demonstrated that dis-
placement of an implant between 30 and 90 µm stimu-
lated bone formation at the implant surface compared
with an unloaded condition. On the other hand, micro-
movement beyond 150 µm can induce the formation of
fibrous connective tissue, preventing osseointegration
of an immediately loaded implant.12–15
An additional difficulty when considering immedi-
ate loading for immediately placed implants is the in-
evitable initial bone defect at the marginal region.37,38
This bone defect increases the crown/implant ratio
and theoretically leads to higher bending moments
acting upon the implant.39
The multivariable approach in the present study also
revealed that, in general, the highest levels of displace-
ment were found for immediately placed implants. Also,
the implant design made the highest relative contribu-
tion to bone-to-implant relative displacement. Although
all implants presented micromovement between 5 and
60 µm within all possible variable combinations, the
ITI Standard design showed the greatest amount of
displacement. These results are in agreement with a
previous study39 that compared the stability of two ITI
implant designs that were immediately loaded after
placement in human cadaver extraction sockets. It was
observed that TE ITI implants, which feature an increased
number of threads, showed better stability than ITI Stan-
dard implants. Further supporting the effect of an in-
creased number of threads, Huang et al,28 in an FEA of
immediately loaded implants, showed that the addition
of threads to stepped and cylindric designs decreased
the implant sliding distance. It should be noted that a
multivariable study considering not only the number of
the threads, but also their geometry, is warranted. The
thread design (ie, thread pitch, depth, and shape) deter-
mines the initial contact, surface area, stress dissipation,
and stability at the bone-implant interface, and thus
the thread function and effectiveness.42 The v-shaped
threads, such as those used in the SIN and 3i implants
tested here, were generally included in the implant
designs for simpler and more efficient placement.43 In
contrast, the reverse-buttress threads of the Nobel
implant were optimized to withstand pull-out loads.
These threads were actually more capable of holding
the implant in the palatal bone of the extraction sock-
et in the immediate placement simulations.43,44 In the
present study, which compared these implant designs, the
Nobel Replace implant had the least micromovement,
followed by SIN and 3i, respectively.

In the immediately placed models, a slightly higher
volume of bone with strain levels above 4,000 µε was
observed for the ITI and 3i implants at the buccal aspect.
These observations are in agreement with the findings
of Bozkaya and Müftü,45 whose FEA showed a larger area
of bone overloading as a result of bending moments for
the ITI system in a comparison with four other implant
systems. The authors reported that, in general, overload-
ing occurred near the superior region of the compact
bone in compression and was caused primarily by the
normal and lateral components of the occlusal loading.
High strain levels were also observed at the apices of
two implant designs (SIN and Nobel) in the immediate
placement scenario; this may be related to the tapered
design of these implants, compared to the more cylin-
dric shape of the other implants.46 On the other hand, the
rounded apical design of the ITI implant allowed for the
lowest degree of stress concentration in the apical region.
In the present FEA, the strains in immediate and de-
layed loading simulations were concentrated mainly in
the coronal region of the implants. In addition, moder-
ate amounts of strain were still found along the implant
body in the immediate loading models. Furthermore,
smaller values and variations in EQV strain and bone-
to-implant displacement were noted between the
implant designs in these situations. These results are
consistent with simulations performed by Ding et al,30
who did not observe significant differences in stresses
and strains among implants with different lengths in im-
mediate loading simulations. The results of that simula-
tion showed that implant diameter was more important
for improved stress distribution in immediately loaded
implants than implant length. This probably results from
the fact that stress distribution inside the repaired bone
socket is uneven, as the elements exposed to maximum
stress are located around the neck. Hence, the character-
istics of the cervical portion of the implants (ie, diameter,
presence or absence of threads, surface roughness, con-
nection type) might exert a greater influence on the dis-
tribution and magnitude of stress with these protocols
compared to the implant body design.
Conversely, in the current investigation, the relative
contribution of the implant design on the differences
in EQV strains was greater for the immediately loaded
implants than for the immediately placed implants.
Since a previous multivariable analysis demonstrated
that the type of implant connection does not signifi-
cantly affect EQV strain levels in immediately placed
implants,24 it is possible that the 9.1% contribution of
implant design observed here arose mainly from the
implant body design. On the other hand, since the
biomechanical support is altered as a result of bone
formation between the socket wall and implant body
in the immediate loading situation, a difference in the
relative contribution from the immediate placement
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Pessoa et al
and immediate loading situations was expected.24,47
Thus, in addition to the contribution of the implant
body design, the 11.4% contribution of the implant
design observed in the present study might also be re-
lated to the additional effect of the unique connection
and crestal module designs of each implant.
As expected, as a result of greater biomechanical sup-
port and model boundary conditions, the lowest strain
values were seen in the current FEA for the delayed
loading models. This result is in direct agreement with
Huang et al,28 who reported a decrease of 28% to 63% in
the values of bone stress for a glued interface (osseinte-
grated implant) compared with a contact interface with
a frictional coefficient of µ = 0.3 (immediately loaded im-
plant). The approximately twofold decrease in the con-
tribution of implant design to the dependent variables
for the delayed loading c­ linical scenario r­elative to the
others also is related to the fact that, in this particular
scenario, 80% to 100% of the stresses were concentrated
at the crestal 40% of the implant.24,48,49
In the present FEA, a scale ranging between 100
and 4,000 µε was used to display the strain state in the
bone. Frost19 considered 4,000 µε a possible threshold
for pathologic bone overload and suggested that higher
strains would lead to the accumulation of microdamage,
leading to bone resorption. In a well designed rabbit ex-
periment, Duyck et al20 estimated in a CT-based FEA the
strain associated with peri-implant bone loss at 4,200 µε.
However, it must be noted that the present investigation
focused only on the relative influence of the different
implant designs on the biomechanical environment of
immediately placed implants, rather than on the mod-
eling of bone adaptive processes. In this way, although
some of the models presented strain above 4,000 µε,
this does not inevitably lead to bone resorption and
implant failure. The loading as modeled in the current
study was static, and bone in situ responds to dynamic
loads.20,50,51 Furthermore, loading frequency and num-
ber of loading cycles, in addition to strain amplitude,
are also capable of greatly influencing the cortical bone
adaptive ­response.22,52,53
The present investigation comprised a multivariable
FEA evaluating the biomechanical behavior of immedi-
ately placed, immediately loaded, and delayed loaded
implants. Although the assumptions that were made
in the development of the finite element models, es-
pecially related to the applied mechanical properties
and boundary conditions, compromise the accuracy of
the absolute values calculated, the integration of multi-
variable statistical analyses and advanced engineering
techniques, such as CT imaging and computer-aided
design systems, to construct FE models with various
interface conditions (contact) provided relevant infor-
mation on the relative influence of different implant
designs on diverse implant clinical scenarios.
The International Journal of Oral & Maxillofacial Implants 1285
Pessoa et al
CONCLUSION
Within the limitations of the present study, the follow-
ing can be concluded.
1. Different implant designs significantly influence
the biomechanical environment (ie, the strain lev-
els and bone-to-implant displacement) of immedi-
ately placed implants;
2. The loading magnitude and the clinical situation
(ie, presence or absence of extraction socket de-
fect, interface condition) make the greatest con-
tributions to variations in equivalent strain and
bone-to-implant displacement;
3. The greatest effect of varying the implant design
was seen for immediate placement and immediate
loading protocols.
4. The implant design did not dramatically affect the
strain values and distributions of delayed loaded
implants.
ACKNOWLEDGMENTS
The authors thank Dr S. Fieuws from the Leuven Biostatistics
and Statistical Bioinformatics Centre (L-BioStat) for the facto-
rial design optimization and analyses of variance. Roberto Pes-
soa gratefully acknowledges the grants and scholarships from
the Research Support Foundation of São Paulo State (project
2006/06844-2), the Committee for Postgraduate Courses in
Higher Education, and the National Council for Scientific and
Technological Development. Siegfried Jaecques gratefully
acknowledges funding from the K. U. Leuven research fund
(project OT/06/58). The CT-based FEM methods are based on
research funded by the EU Framework Programme 5 Quality of
Life project QLK6-CT-2002-02442 IMLOAD.
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