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Biomaterials and Biomechanics in Dental Implant Design John B JOMI on CD-ROM, 1988 Feb (85-97 ): Biomaterials and Biomechanics in Dental Implant … Copyrights © 1997 Quinte… Biomaterials and Biomechanics in Dental Implant Design John B. Brunski, PhD This article seeks to give the clinician insight into the design process and biomaterial/biomechanical aspects of endosseous implant design. Specific facets considered relate to materials, implant shape, special surface coatings, shock-absorbers, and the implant-tissue interface. (Int J Oral Maxillofac Implants 1988;3:85-97) Key words: biomaterials, biomechanics, design, forces, interface, stress transfer Bioengineering is critical in dental implant design. The object of this article is to summarize knowledge about biomaterials and biomechanics of dental implants to help a clinician confront the following questions: Why are there so many different implant biomaterials and shapes? Should implants have special coatings on the surface, and if so why? Should an implant have some sort of built-in shock absorber? Is there a certain optimal implant-tissue interface, and if so, in what respect is it optimal? The goal is to give the clinician insight into the design process and biomaterial and biomechanical aspects of implant design. A clinician who thinks about dental implants from the design perspective will demand answers to the following questions: What are the objectives for a particular dental implant system? What is the rationale for trying to achieve the objectives in the way proposed? Are the objectives achieved in practice? Attention will be restricted to endosseous (endosteal) dental implants. Design process Design means to create according to a plan.1 The word design indicates a process, not an end product such as the particular shape or material of a dental implant. Shape and material are only two of the many considerations in the multivariable design problem for dental implants. The design process is a generic approach to problem solving and consists of these steps1: 1. Identification of a need 2. Definition of the problem (and sub-problems) to be solved 3. Search for necessary background information and data JOMI on CD-ROM, 1988 Feb (85-97 ): Biomaterials and Biomechanics in Dental Implant … Copyrights © 1997 Quinte… 4. Formulation of objectives and criteria 5. Consideration of alternative solutions to the problem 6. Analyses and evaluations of alternative solutions 7. Decision-making and optimization Design has some identifying characteristics. A complicated design problem will usually be broken down into sub-problems, so these can be addressed separately and then considered together in reaching final solutions. Often, design must go forward even when there is missing or unknown information. In design, judgments about the quality of a solution are made by measuring performance against the stated goals, not the other way around. Finally, design is often iterative. There may be a need to design and redesign several times to optimize performance with respect to goals. There may be no perfect solution to a design problem, but instead a compromise solution representing the best solution under conflicting constraints. Engineering design In applying the design process to dental implants, it is easy to identify the need (step 1) for an implant. It is also easy to define the problem (step 2). What can be difficult is translating these generalities into specifics. Exactly how will the problem be solved? Initial questions are: What are the "masticatory functions" that will be restored (step 3)? How will design criteria for implants evolve from this (step 4)? What are alternative approaches to achieving the goals (step 5)? It is critical that steps 1 to 4 be followed. If these steps are clear, then steps 5, 6, and 7 outline a path toward creating, evaluating, and optimizing a proposed solution to the problem. But if steps 1 to 4 are missing or ambiguous (as they are for some current dental implants), then it becomes difficult if not impossible, to understand the whole process. The importance of clearly stating the problem to be solved; the design goals; the rationale for solving the problem via a certain approach; and the evidence that the chosen approach does, or does not, satisfy the design objectives can't be overemphasized. Trial and error and intuition have legitimate places in design, but if these are the only elements in the process, then this should be acknowledged. There is nothing intrinsically wrong about a trial-and-error solution to a design problem. However, it usually indicates that the designer isn't sure why the solution works. This also means that the designer may not be sure when it will not work. Even if something "works," it is useful to know why. How do biomaterials and biomechanics fit into dental implant design? These JOMI on CD-ROM, 1988 Feb (85-97 ): Biomaterials and Biomechanics in Dental Implant … Copyrights © 1997 Quinte… subjects represent only two of many subproblems in the entire design effort. Any implant must be constructed from a biomaterial. The biological performance of the chosen biomaterial will be of concern. Dental implants must function biomechanically, so biomechanical issues will arise. Implantation surgery, postoperative care, periodontal health, patient physiology, costs to the patient, and other aspects also are key subproblems in implant design, but these go beyond the scope of this review. Subproblems Biomechanics is the application of engineering mechanics (statics, dynamics, strength of materials, and stress analysis) to the solution of biological problems. Biomechanics pertains to dentistry because the teeth and jaw perform biomechanical activities during mastication.2 Biomaterials deals with the effects of an implanted material on the body and vice versa. Biomechanical and biomaterial subproblems are depicted in Fig 1. First, any dental implant, regardless of its biomaterial or shape (Fig 2), will be exposed to intraoral forces and moments. These loadings may be appreciable and the implant must withstand these loadings without being damaged. Second, the implant has to be supported within the jaw by some method which will involve biomaterial and shape factors. Third, the implant will transmit loading to the interfacial tissues around the implant, which then must tolerate them without adverse tissue response. The problem is selecting the material and shape of the implant so the implant functions properly. Background A design problem cannot begin to be solved without background data or information. For implants, prior research has provided some—but not all—of the biomechanical and biomaterial data for design. Following is a synopsis of background research pertaining to implant design. In vivo loadings. Vertical components of chewing forces have been reported for patients with natural teeth and for patients wearing conventional and implant-supported dentures (Table 1). The normal human dentition is capable of exerting large forces. Axial components are in the range of 200 to 2,440 N, and lateral force components are of the order of 30 N (a newton is approximately the weight of one apple; 1 N = 0.2249 lb). For dentures supported by dental implants (fixtures) workers in Sweden8 have measured vertical closure forces of 42 to 412 N. Implant design must distinguish between closure forces and vector components of forces and moments on individual implants supporting a bridge (Fig 3). While JOMI on CD-ROM, 1988 Feb (85-97 ): Biomaterials and Biomechanics in Dental Implant … Copyrights © 1997 Quinte… closure forces are useful, individual loading components on implants are required for detailed design analyses of implants and surrounding interfacial tissues. Unfortunately, except in animal studies,14 no direct measurements are available for loading components on dental implants in vivo, although data may be forthcoming.15 Without these data, in vivo forces must be estimated on dental implants, and the estimates used for stress analyses of implants or interfacial tissues. These analyses will only be as good as the input information, which is approximate at this time. Implant properties. Implants should not fracture, yield, fatigue, wear, or otherwise fail during in vivo use. Failure prevention necessitates testing and stress analyses of the implants and tissues. Assuming there is accurate background data on typical implant loading (which is limited, as previously noted), the problem is to select adequate intrinsic and structural mechanical properties of implants. Intrinsic properties pertain to the material and not its shape. They include a material's elastic moduli, yield point, ultimate tensile strength, compressive strength, fatigue strength, and hardness. (For corrosion behavior, intrinsic properties could also be defined.) Values can be found in textbooks and literature, or they may be directly measured via standard test methods.16-19 Caution is advised in using handbook values, because manufacturing processes can cause significant property differences between raw material and the finished product. Structural mechanical properties embody both the intrinsic material property and the geometrical shape of the device being considered. For example, the deformability of a beam in bending depends on the product EI (flexural rigidity), where E is Young's modulus of elasticity and I is the second moment of area of the beam's cross-section. The deflections of a cantilevered dental bridge could be inappropriate even when the bridge is made of a strong, high-modulus (E) dental alloy because its deflection under
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