KNUDSON,

Fig.
Fig.

WILLIAMS,

AND

KEMPLE

2. Verification jig made on master cast.

3. Verification jig placed intraorally to determine accuracy of master cast. Note that

each transfer coping has a positive seat on each abutment cylinder.

Inc., Anaheim, Calif.) material is applied and activated by

the catalyst. The verification jig can be used intraorally to
confirm the accuracy of the mastercast at the next appointment before making maxillomandibular jaw relation records
(Fig. 3).

ter cast. In addition, the jig can verify the accuracy of subsequent castspoured from the sameimpression.The verification jig can eliminate the making of a framework on an
inaccurate cast.

SUMMARY

DR. Rom&
C. KNUDSON
WILFORD HALL MEDICAL CENTEREGDP
LACIUAND
AFB, TX 78236

This article presentsa simplified technique for the fabrication of a verification jig to check the accuracy of the mas-

Basic biomechanics

of dental

implants

in prosthetic

dentistry

E-J. Richter, Dr.Med.Dent., Dipl.-Ing.*

AachsnUniversity MedicalCenter,Aachen,WestGermany
A discussion of loads applied to implants must include the clinical consideration
that not only rigid implant types are used, such as the Ttibingen
immediate
implant
and the TPS screw implant without
shock absorber, but also systems with inherent
resilience
integrated
in the implant design, such as the IMC and Flexiroot
implants.
The common goal of all of these implant systems is to achieve a stable anchorage
of
the implant body in the bone tissue, that is, contact osteogenesis
or osteointdgration. In the implant-to-bone
interface region there is an implant mobility
resulting
from the elasticity
of the bone. The question of whether
additional
implantintegrated
elastic elements are necessary to simulate the periodontal
attachment
is
controversial.
(J PROSTHET
D~~~1989;81:602-9.)

discussionof loads applied to implants and the

reactionsin bonemust include the clinical considerationthat
not only rigid implant types such asthe Frialit (Tuebingen
type, Friedrichsfeld, West Germany) implant for immediate
extraction sites, Linkow (Oratronics Inc., New York, N.Y.)

*Departmentof Prosthcdonticsand

602

Dental

Materials.

implants, and the titanium plasma-coated screw (TPS)

(Park Dental Research, New York, N.Y.) without shock
absorber are used,but alsosystemswith the resilienceintegrated in the implant designsuch as the intramobile cylinder implant (IMZ) (Interpore-IMZ, Irvine, Calif.) and
Flexiroot (F.A.I.R., Inc., Bala Cynwyd, Pa.) implants. The
common goal of all implant systemsis to achieve a stable
anchorageof the implant in the bone tissue (osteointegra-

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sbml
t
Resilience
0, =lQOOONlmm

ANNI

Fig.

10

3. Force movement ratio of osteointegrated implant.

4
I

II

1. Schematic drawing of tooth mobility with characteristic parameters. s = Elastic movement; F = load.
Fig.

7
r
I

ds
I

dt

z2

z,

///

//

IF72

fR2

g = Load rate

& ////
yr

2. Load-rate 2 determines level from which sec0

ondary phaseof movement starts.

Fig.

tion). In the implant-bone interface region there is implant

mobility resulting from the elasticity of the bone. The question is controversial whether additional implant-integrated
elastic elementsare necessaryto simulate a periodontal ligament.
Clinical results showthat in the edentulouslower jaw implant, resilience seemsto be of subordinate importance,
whether there is a fixed denture with a chewing surface of
acrylic resin teeth on Branemark (Nobelpharma, Weston,
Mass.) implants, or a removable complete denture, barguided according to the conceptsof the TPS or IMZ system.
However, in the posterior region the situation is more complicated. The successof a fixed partial denture on atooth and
an implant dependson the interaction of the elastic mandible, mobile teeth, and directly loaded implants placed in the
chewingcenter. For thesereasonsthere is a need to brake
the load and to integrate shock-absorbingelements, using
specialimplant designsto avoid stressand overloadingof the
mandible, the teeth, and the implants.
Frequently, craterlike regionsof bone destruction around
an implant may be seenafter a relatively short time in function. The reasonmay be the loading of the implants, especially traumatic overloading.

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z1
///////

4. Load distribution on normal fixed partial denture

on natural teeth (Zi and Zs).
Fig.

THEORETICAL

BASIC

ASPECTS

With the help of mechanical calculations (statics, firmness,and dynamics) it is possibleto define the load of a restoration that is fixed on an implant and a tooth and to register the reactions in bone. There is only one possiblekind
of load on an implant or a restoration, which is a force that
causesreacting forces and bending momentums* in the
bone. Becauseteeth and implants are not freely movable in
the jaw, a balance of forces and bending momentumsis essential. A load from outsideonto a systemcausesinner stress
in the system and stressreactionsin the bone anchoragethat
areof the samevalue but in oppositedirections. Action is like
reaction.
After lossof the molars in a lower jaw and insertion of an
implant, a modern fixed, conditionally removable fixed par-

*A momentum

is the product

of force

and length

of a lever-arm.

RICHTER

n ~1, n=f (D, I

M = F(l-l/n).1
7. Load distribution of normal fixed partial denture
with different abutments (Z). Load (F) on more yielding
abutment Z causesmomentumat lessyielding abutment I.
Fig.

6. Load distribution on cantilever fixed partial denture on natural teeth (Zr and 22).
Fig.

soft resilience :

strong resilience :

large yielding

little

yielding

resilience

DI 02
6. Mechanical principles of normal fixed partial denture fixed on tooth (2) and implant (1,).
Fig.

tial denture to the last premolar could be provided. The essential biomechanicalfactor is the different functional support of the two abutments.

INFLUENCE

OF VERTICAL

FORCES

A tooth hasa two-stagemobility under physiologic stress

(Fig. 1). The resilience(the quotient of force [F] and elastic
604

movement [s]) differs about the factor of 10 for areasI and

II. To be specific,the initial phaseof the movement of a tooth
is influenced by the load-rate in addition to the amount of
load. The higher the load-rate, the deeper the level from
which the secondaryphaseof movement starts (Fig. Z).l
The mobility of an osteointegrated implant is lessthan
that of a tooth and becauseof the missingperiodontal ligament there is no initial increase(Fig. 3).2 The resilience of
approximately 10,000 N/mm is approximately 10 to 100
times higher compared with a tooth.
By using implants as an abutment it is possibleto make
normal fixed prostheses-a successfultherapy in prosthodontics. But the different anchorageof tooth and implant
is important. The abutments of a normal fixed partial denture and a cantilever fixed partial denture on natural dentition have the samekind of anchorage.
The mechanicalprinciples are shownin Figs. 4 and 5. Both
restorations have the samelength, a vertical force is placed
in the middle or at one end. The springsZi and Z2may characterize the effect of the periodontal ligaments.The stressin
the abutment teeth can be determined by using the rules of
mechanicalbalance.Fig. 4 showsthat the load (F) is equally
distributed between both abutment teeth for a normal fixed
partial denture; however, if the force (F) is placed at the left
end of the fixed partial denture, all of the load is carried by
the left tooth, the sameas in the middle loaded cantilever
fixed partial denture (Fig. 5). When the outer load (F) is
placed on the end of the lever-arm, the distal abutment has
to carry twice the force (F) and the mesialtooth is stressed
extrusively.
The situation of a fixed partial denture supported by a
tooth and an implant is shown in Fig. 6. The different
anchoragesare expressedby the stiffnessof the springs,signified by the width of the lines. The resilienceof the implant
abutment (DI) is lessthan that of the tooth (Dx).
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with

F-1N:

D,=lOON/mm

16
11

12
10
8

6
4
2
O,[Nlmml

8. Reacting momentum (MI) in bony implant anchoragein dependenceof stiffness

(Dz) of tooth by variation of resilience (Dr) of implant. (Technical data: length of fixed
partial denture, 16 mm; cross-section,6 X 6 mm; elastic modulus, lo5 N/mm2; load on
dental abutment, 1 N.)

Fig.

Becauseof high yielding of the soft spring, the ligament,

there must be bending on the right spring, the implant, and
the surrounding bone. That bending meansthat only a part
of the musclepowerflows through the tooth, the other part
flowsasa bending momentum through the implant into the
bone (Fig. 7). Only part of the force (F) is carried by the
tooth, and a reacting momentum (M) results in the bone implant anchorage.This meansone can find an unfavorable
load distribution to the lessyielding abutment: exoneration
of the tooth and bending of the implant.
To obtain numerical details, a computer program (PINUS-RZ, Cubus AG, Zurich, Switzerland) wasused. In this
calculation the fixed partial denture is 16 mm long and the
dental abutment is stressedwith an occlusalload of 1 newton (N). The reacting momentum (MI) of the implant is dependent on the stiffness(Dz) of the tooth while the resilience
(Dr) of the implant abutment is varied asshownin Fig. 8. In
the region of normal tooth mobility (the hatched zone) there
isstill a momentumof a quarter of the maximum value. With
the useof an advantageoustechnical construction, this momentum could be minimized.
On the other side, a load directly applied on the lessyielding abutment in the center of the implant axis doesnot influence the highly elastic tooth (Fig. 9). There will not be a
momentum in the bone around the tooth socket.
The sameyielding of teeth and implants aswell asthe antagonist teeth in centric occlusionis therefore of enormous
importance. The distinguishing marks of a harmonioussystem are occluding units that can yield equally according to
their position in the dental arch. In natural dentition, each
of two opposingteeth will yield approximately 15 pm if the
jaws approach 30 Mmafter initial contact when the muscles

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z Dz
iL
9. No load distribution on normal fixed partial denture with different abutments (2, I): load (F) on stiffer
abutment I causesonly smallmomentumat abutment Z with
high yieldability.
Fig.

flex. As shown in Fig. 10, just that part of the muscle-force

will be transmitted that equals5 N. If there is an implant
instead of a tooth and if the conditions of harmoniousyielding of 30 pm should be fulfilled, a load of 16 N must be established (Fig. 11). That meansthat (1) the implant and the
antagonist tooth are stressedmuch higher than in the natural dentition and (2) the antagonisttooth must equalizethe
missingyieldability of the implant.
By diminishing the occlusalcontacts, one is trying to deactivate the occlusalsituation. This meansthat an occlusion
gold foil of approximately 10pm in thicknesswould not hold
if the teeth just contact each other and no muscleforce is
exerted, But as Fig. 12 showsthere is only a partial reduction in the transmitted load.

605

RICHTER

Tooth

F IN1

Stat lSN)=

30pn

loTooth

152051 [pm1

10. Force-movement ratio of two antagonistic teeth. (Upper part: way of upper
tooth; lower part: way of lower tooth.) After initial contact both teeth yield approximately
15 pm and transmit load of 5 N.
Fig.

25
Tooth

20

10

16
FIN1

Implant

Sl tpml

11. Force movement ratio of tooth (upper jaw). In centric occlusionwith harmonic
resiliencefor all antagonistic units (30 pm) 16 N are transmitted.
Fig.

The schematic drawings describe the clinical situations

with reservations. The changing of bone tissue for instance
isnot taken into consideration, but the drawingsexplain the
theoretical biomechanics. To avoid a traumatic implant
load, possibleprocedures to deactivate the implant stress
could be detailed by using these diagrams.
Fir&possibility.
Diminishing the occlusalcontacts almost totally causesonly a parallel shifting of the implant
characteristic inferiorly (Fig. 13) becausethe anchorageof
the implant in bone and the implant design itself is not
changed.
Se&w& possibility.
Fig. 14 showsthat integration of a
soft cushioningelementasa springwill changethe implant
606

characteristic sothat the systemmight behave like a tooth.

Thirdpossibility.
By using a specialbuffering element,
the characteristic of an implant can better simulatethe twostagemobility of a tooth (compareFig. 15 with Fig. 10). This
implant design has the advantage of continuous even support of the occluding units with a normal load by using the
effect of the sameyielding of the abutments. The implant
characteristic should be steeper than that of the tooth to
avoid overloading the implant.

INFLUENCE

OF HORIZONTAL

FORCES

An implant is located in the jaw like a tooth, sothat horizontal forces will causesimilar reactions in the bone (Fig.
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Tooth

a
!

--

-i-

.-

Fig. 12. Force-movement ratio of tooth (upper jaw) and implant (lower jaw). To come to
total resilience of 30 pm, load of 8.5 N still is needed.

Tooth

$3

3513

Stot3= a l ha + %+ 513
10 eJ3 = 43
Star

xl

--

ISNI a 3Opm

----

Implant
tm~if~d)

&a

Fig. 13. Effects of procedures to avoid overloading of implant. Diminishing occlusal contacts almost totally causes parallel shifting of implant characteristic inferiorly.

Tooth

Fu, = h,
Sto+ l4,25Nl=
4.25

Mpm
10

FWI

a
10
Implant
(modified)

Fig. 14. Effects of procedures to avoid overloading of implant. Integration of soft

cushioning element. Implant characteristic is similar to secondary phase of tooth mobility.
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607

RICHTER

*,3

Tooth

f 33

Stot3 = %3+ 513

Fu = 53
Stat

IL.5 Nl = 30pm
F IN1

Implant
(modified

Fig. 15. Effects of procedures to avoid overloading of implant. Imitation of two-stage

yieldability without reduction of occlusal contacts-ideal
adaptation of normal tooth mobility.

-C

Strain
(&g]
plane

Model

Model

Model

Fig. 16. Reactions in bone caused by horizontal force (F).

Model a: stress (qualitatively) in cortical and spongy bone;
model b: simplification of model a; model c: similar to model
b, but reacting stress expressed as reacting forces FK and Fs.
Fig. 18. Eccentric vertical load causes same reacting forces:
in bone as direct horizontal load to implant. (F = force;
M = momentum.)

Fig. 17. Mechanical principles to explain loading of implant and cantilever fixed partial denture. (F = force.)

16). Model a considers the stress in cortical and spongy bone,

model b is a simplification, and if the bone reactions are not
interpreted as stress but as forces, model c has to be used.
If model c is turned to the left side and the arrangement
of forces is compared with that of the cantilever fixed par-

tial denture (Fig. 5), the same situation exists (Fig. 17). In
each instance, the reacting force nearest to the free lever-arm
has the highest amount (Fig, 17,F~). This is the reason that
prosthodontists have a cautious approach to cantilever fixed
partial dentures.
Consequently horizontal loads to implants cause high
stress in cortical bone. This confirms finite element
calculations.3*4 Mechanically it is unfavorable because the
margin of the bone has to react as an implant-supporting element. The development of craterlike bone destruction is
combined with a transfer of the load-supporting region to the
better conditioned inner parts of the bone, but clinically periodontal problems often arise. A narrow and plain chewing
surface is best to avoid strong horizontal loads to implants,
with occlusal contacts within the implant diameter and free
articulating movements without bruxism.

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slightly wider than in the central part (Fig. 19). There is no

overloading of the bone in the critical zones because there is
more space and the ligament itself could be displaced. The
eflkiency of this perfect construction is evident in the success of conventional treatment with fixed prostheses.

SUMMARY
Although it is possible to describe the biomechanics of
implants by use of mechanical principles, only relative conclusions are possible because the limiting level for stress in
bone is unknown.
Implants with definite resilience integrated in the implant
design can diminish stress in bone so that the goal of
improving implants should be to avoid bending of the
implant and to achieve a mobility that is almost equal to that
of the natural teeth.
REFERENCES

Fig. 19. Periodontal space is wider in apical and marginal

region than in central part.
An eccentric vertical load causes the same reacting forces
in the bone as a direct horizontal load to the implant (Fig.
18). The discussion of loads applied to implants should include the characteristics of the periodontal ligament. In the
apical and marginal region the periodontal ligament is

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DENTISTRY

1. Richter E-J. Die badeutung der versuchsbedingungen

im wissenschaftliehen experiment,
dargestellt am beispiel der zahnbeweglichkeit.
Dtsch
Zahnantl 2 1985;40:404-9.
2. Spiekermann
H. Implantatprothetik.
In: Voss R, Meiners
H, eds.
Fortechritte
der xabnaerztlichen
prothetik und werkstoffkunde.
2nd ed.
Munich: Hanser, 1984;189-218.
3. Soltesz U, Siegele D. Einfluss der steifigkeit des implant&materials
auf
die im knochen erxeugten spannungen. Dtsch Zahnarstl 2 1984;39:183-6.
4. Borchers L, Reichart P. Three-dimensional
stress distribution
around a
dentai implant at different stages of interface development.
J Dent Res
1983;62:155-9.
Reprint requests to:
DR E-J. RCHTFZ
UNNERSY
OF AACHEN
DEPARTMENT OF PR~~o~~~~
5100 AACHEN, PAUWELS~~E
WEST GERMANY

AND DENTAL MATERIALS

609