journal of dentistry 40 (2012) 467474

Available online at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/jden

Effects of different implantabutment connections on

micromotion and stress distribution: Prediction of microgap
formation
Syafiqah Saidin a, Mohammed Rafiq Abdul Kadir a,*, Eshamsul Sulaiman b,
Noor Hayaty Abu Kasim b
a

Medical Implant Technology Group (MediTeg), Faculty of Biomedical Engineering & Health Sciences, Universiti Teknologi Malaysia, 81310
Johor Bahru, Malaysia
b
Department of Conservative Dentistry, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia

article info

abstract

Article history:

Objectives: The aim of this study was to analyse micromotion and stress distribution at the

Received 25 July 2011

connections of implants and four types of abutments: internal hexagonal, internal octago-

Received in revised form

nal, internal conical and trilobe.

15 February 2012

Methods: A three dimensional (3D) model of the left posterior mandible was reconstructed

Accepted 16 February 2012

from medical datasets. Four dental implant systems were designed and analysed independently in a virtual simulation of a first molar replacement. Material properties, contact
properties, physiological loading and boundary conditions were assigned to the 3D model.

Keywords:

Statistical analysis was performed using one-way analysis of variance (ANOVA) with a 95%

Micromotion

confidence interval and Tukeys Honestly Significant Difference (HSD) multiple comparison

Implantabutment connection

test.

Stress distribution

Results: The internal hexagonal and octagonal abutments produced similar patterns of

Finite element method

micromotion and stress distribution due to their regular polygonal design. The internal
conical abutment produced the highest magnitude of micromotion, whereas the trilobe
connection showed the lowest magnitude of micromotion due to its polygonal profile.
Conclusions: Non-cylindrical abutments provided a stable locking mechanism that reduced
micromotion, and therefore reduced the occurrence of microgaps. However, stress tends to
concentrate at the vertices of abutments, which could lead to microfractures and subsequent microgap formation.
# 2012 Elsevier Ltd. All rights reserved.

1.

Introduction

Dental implant restoration has been widely accepted as one of

the treatment modalities to replace missing teeth and to
restore human masticatory function.1 Most dental implant
systems consist of two main parts: the abutment and the

implant body.2 Microgaps between the implantabutment

interface may cause microbial leakage3,4 as microorganisms
can penetrate through a gap as small as 10 mm.5 This
penetration will result in bacterial colonisation through
plaque formation at the interface of the implantabutment
complex,68 leading to inflammation in peri-implant soft and
hard tissues. In the worst-case scenario, such inflammation

* Corresponding author at: P23, MediTeg, FKBSK, 81310 Universiti Teknologi Malaysia, Johor Bahru, Malaysia. Tel.: +60 7 5535961;
fax: +60 7 5536222.
E-mail address: rafiq@biomedical.utm.my (M.R. Abdul Kadir).
0300-5712/$ see front matter # 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2012.02.009

468

journal of dentistry 40 (2012) 467474

will cause gingivitis, bone loss, and eventually, implant

failure.6,7,9 Although peri-implant therapy can be used to
treat peri-implant disease, bone loss that has already occurred
is irreversible, and implant failure is still a common
complication following therapy.10 It is therefore prudent to
prevent bacterial colonisation by having a tight seal at the
implantabutment interface.
Three main factors have been identified as possible causes
for the formation of microgaps: occlusal load during physiological function,11 manufacturing tolerance12 and micromotion between the implantabutment connection. Different
types of abutment connections have been reported to produce
different magnitudes of micromotion.11,13 Two major types of
abutment connections are the conical and the butt-joint, the
latter type of connection being available in at least three
different forms: hexagonal, octagonal and trilobe.2
The design configuration of the abutment connection also
plays a vital role in uniformly transferring occlusal stresses to
the bone, thus eliminating potential microgap formation due
to uneven loading.14 The sharp angles and vertices at
abutment connections induce high stresses, causing wear,

and therefore causing microgap formation.15 Micromotion

and stress are believed to play pivotal roles in microgap
formation and microbial leakage. Different designs of implantabutment connections are predicted to induce different
patterns of micromotion and stress distribution under occlusal loading, the parameters of which were analysed with Finite
Element Modelling (FEM).

2.

Materials and methods

2.1.

Three-dimensional model design

A two-piece abutment was designed using three-dimensional

(3D) Computer Aided Design (CAD) software (Solidworks 2009,
Dassault Syste`mes Solidworks Corp., USA). For optimal
performance, the dimensions of the implant were chosen to
best fit the dimensions of the tooth roots. As shown in Fig. 1(a),
four different features of the abutment connection were
modelled from the generic model: internal hexagonal, internal
octagonal, internal conical and trilobe. Based on the average

Fig. 1 (a) Four different features of the abutment connection: internal hexagonal, internal octagonal, internal conical and
trilobe, (b) Dimensions of the cylinder-screwed dental implant body with a two-piece abutment.

469

journal of dentistry 40 (2012) 467474

thickness of the attached mucosa, the transgingival height of

the abutment was set at 1.6 mm. The bevel angle was set at 508
to simulate the crown margin. It has been reported that the
introduction of a marginal angle of restoration increases the
potential for marginal chipping16; however, this issue is
beyond the scope of our study. The abutment height was
set at 3.5 mm to allow an occlusal clearance of 2.0 mm. Fig. 1(b)
shows a two-dimensional (2D) model of a cylinder-screwed
dental implant body with a two-piece abutment as separate
parts. The length and diameter of the implant body were set at
10.0 mm and 4.5 mm, respectively, based on the average molar
root dimensions. Based on the thickness of the attached
cortical bone, the length of the machined surface at the neck of
the implant body was set at 2.0 mm. A progressive buttress
thread with a larger depth towards the apex and a pitch of
0.8 mm was used.17,18
To simulate the physiological conditions of implant
placement, a 3D model of the posterior section of the human
mandible was reconstructed from 2D Computed Tomography
(CT) datasets. The reconstruction of the mucosa, cortical bone,
cancellous bone, dentine and enamel were carried out using
image processing software (Amira 4.0, Visage Imaging GmbH,
Germany). The 3D models of dentine and enamel were
combined and used to develop a 3D model of the second
premolar and second molar; the first molar was then
converted into a crown. The thickness of the cortical layer
was modelled directly from CT datasets and was between 0.9
and 3.2 mm. Based on the literature reports, the thickness of
the mucosa was manually varied from 0.5 to 2.35 mm.19 The
abutment was screwed to the implant body to facilitate crown
placement.2 As shown in Fig. 2, all components were
converted into 3D models in this study.

2.2.

Material properties

The posterior mandible was assigned Type II cancellous bone

properties with a Youngs modulus of 5500 MPa and Poissons
ratio of 0.3.20 The Youngs moduli and Poissons ratios for
cortical bone, mucosa and crown were set at 13,700 MPa and
0.321; 2.8 MPa and 0.421; and 68,900 MPa and 0.28,15,22

respectively. The 3D models of enamel and dentine were

assigned Youngs moduli and Poissons ratios of 40,000 MPa
and 0.3, and 15,000 MPa and 0.31, respectively.23 The properties of titanium alloy were assigned to the abutment screw,
abutment and the dental implant body with a Youngs
modulus of 110,000 MPa and Poissons ratio of 0.35.2426 All
3D models were considered to be homogenous, linear and
isotropic.

2.3.

Finite element method

In the simulation, the bone surrounding the implant was

assumed to be completely healed. Axial and buccolingual
loads were applied to the crown, second premolar and second
molar to simulate the maximal occlusal force, as shown in
Fig. 2. For axial loading, a force of 230 N was applied to the
second premolar, 300 N to the crown and 350 N to the second
molar.27 A buccolingual load of 100 N was also applied and was
308 from the occlusal plane. The inferior border of the
mandible was constrained in x, y and z directions in the
mesial and distal directions (Fig. 2). All analyses were
performed using finite element software (MSC.Marc Mentat
2005, MSC.Software Corporation, Santa Ana, CA, USA).
A friction coefficient of 0.3 was assigned to seven
contacting surfaces: boneimplant, mucosaimplant, implantabutment, abutmentscrew, abutmentmucosa, abutmentcrown and crownmucosa. No frictional contacts were
assigned between cortical bone, cancellous bone, mucosa,
dentine and enamel, as these bodies were bonded to one
another. The size of the element mesh for the whole 3D model
was set to less than 0.4 mm to maintain the complexity of the
model, and for convergence purposes, it was five times smaller
than the one suggested by Lin et al.28 The total number of
tetrahedral elements is listed in Table 1.

2.4.

Statistical analysis

The mean values for relative micromotion (mmicro) and the

equivalent von Mises stress (mEQV) for internal hexagonal,
internal octagonal, internal conical and trilobe abutments
were calculated with a 95% confidence interval. One-way
analysis of variance (ANOVA) (Minitab 14, Minitab Inc., USA)
was used to determine the significance of differences in
micromotion and EQV for different shapes of the abutment
connections. As the data were not homogenous, Tukeys
Honestly Significant Difference (HSD) multiple comparison
test was chosen to identify the pairs of data that were
different, thus defining the abutment connection that would
most affect the measured parameters. Conclusions about the
statistical analysis were based on the calculated HSD values.

Table 1 Total number of tetrahedral elements of the

components.

Fig. 2 Cross-sectional view of the finite element mesh of

the region of interest.

Abutment connection

Total number of elements

Internal hexagonal
Internal octagonal
Internal conical
Trilobe

509,
508,
515,
508,

979
489
904
503

470

journal of dentistry 40 (2012) 467474

No significant differences existed between two designs if

HSD > mi  mj. However, if HSD < mi  mj, one of the designs
was said to have produced different levels of micromotion or
stress distribution compared with the other one. The HSD
value was calculated using the following formula:
s


MSw 1
1

(1)
HSD qa;k;DFw 
n1 n2
2
where qa;k;DFw is the critical value of statistical data and is
equal to 3.63; a is the significance level; k is the number of
samples; DFw is the degree of freedom within a sample; MSw is
the mean square within the sample and n is the number of
data points.

2.5.

Rotational freedom

Two different equations were used to calculate rotational

freedom.29 For regular polygonal designs consisting of internal
hexagonal, internal octagonal and internal conical abutments,
rotational freedom was calculated using the following
formula:




360
180
C
 2  cos1 cos

(2)
a
R1
n
n
where a is the rotational freedom; n is the number of edges; C is
the clearance and R1 is the radius of the width across the

corner. Rotational freedom of the polygonal profile or trilobe

abutment was calculated using the following formula:
!
"
2
2
2
1 D d  K R2 C
a 2  cos
2dD
!#
2
2
D d  K R2 2
 cos1
2dD
where a is the rotational freedom; D is the distance from the
centre of the outer arc of the implant to the rotational axis of
the abutment; d is the distance from the centre of the inner arc
to the rotational axis of the abutment; K is the radius of the
inner arc; R2 is the radius of the outer arc and C is the
clearance. The clearance is the length of the actual gap between the abutment and the implant body. The clearance was
set to 0.1 mm for both formulae to represent the perfect-fit
conditions at the implantabutment interface.

3.

Results

3.1.
Micromotion and equivalent von Mises stress (EQV)
analyses
Fig. 3(a) shows micromotion of the abutment relative to the
implant body and the crown. Significant micromotion was
observed occlusally at the implantabutment connection, and

Fig. 3 (a) Micromotion of the abutment relative to the implant body, (b) Equivalent von Mises stress of the abutment from
the lingual view.

471

journal of dentistry 40 (2012) 467474

Table 2 Analysis of Variance of the four components.

Abutment connection

Micromotion (mm)
Mean (SD)

Internal hexagonal
Internal octagonal
Internal conical
Trilobe
*

1.02
1.16
1.22
0.20

(0.88)
(1.02)
(1.04)
(0.19)

Max
3.71
3.94
5.67
0.94

EQV (MPa)
Mean (SD)
48.01
46.76
47.25
37.91

(28.31)
(27.12)
(28.10)
(21.74)

Micromotion
Max

187.77
164.47
167.61
155.44

DFw
2323

MSw
0.78

EQV
F

DFw
*

119.81

10,890

MSEw
704

F
83.70*

P value < 0.05.

Fig. 4 The degree of rotational freedom for the four types

of abutment connections.

it gradually decreased towards the inferior region of the

abutment. Less micromotion was observed for internal
hexagonal and internal octagonal abutments. However, the
trilobe connection showed a high concentration of micromotion at its polygonal profile. ANOVA (Table 2) revealed a
significant difference in micromotion among the four types of
abutment connections. Further analysis using Tukeys test
revealed differences in micromotion for all abutment connections, except for the pair of internal octagonal and internal

conical abutments. Table 2 also shows the maximal value of

micromotion for all simulated models, with the internal
conical abutment showing the greatest magnitude and the
trilobe showing the least.
Fig. 3(b) shows an EQV contour plot of the abutment from a
lingual view. High stresses were concentrated in the lateral
apical region of the regular polygonal abutment. The trilobe
abutment produced high stress in the superior region of the
implantabutment connection, whereas the internal conical
abutment showed more uniformly distributed stress at the
implantabutment connection when compared with the other
two internal abutments. ANOVA (Table 2) revealed significant
differences in the stress distribution for at least one of the
abutment connections. Tukeys test showed that the trilobe
was the only connection that produced different levels of
stress distribution. As seen in Table 2, the internal hexagonal
showed the greatest magnitude of EQV, followed by the
internal conical, the internal octagonal, and finally, the trilobe.

3.2.

Rotational freedom

The degree of rotational freedom is shown in Fig. 4 for four

types of abutment connections. The trilobe connection had
the lowest degree of rotational freedom compared with the
other three abutment connections, suggesting a more restricted rotation for the polygonal profile than for the regular
polygonal abutment.

Fig. 5 (a) Cross-sectional view of the stress distribution around the cancellous and cortical bone, (b) Anterior view of stress
distribution for the analysed region of interest.

472

journal of dentistry 40 (2012) 467474

Fig. 6 The deformation of dental implant body under the

applied load at 100T magnification.

3.3.

Deformation

Fig. 5(a) shows a cross-sectional view of the stress distribution

around the cancellous and cortical bone. High levels of
stresses seen around the boneimplant and the boneadjacent
teeth interfaces gradually decreased towards the inferior
region of the bone and were concentrated around the apex of
the implant body. Fig. 5(b) shows the anterior view of stress
distribution around the bone. High stress levels were more
concentrated in the buccal region as the implant and the
crown bent buccally under the applied load; the bending
direction can be clearly seen in Fig. 6 at 100 magnification.

4.

Discussion

The finite element method has been widely used for

biomechanical analysis of human joints and implants.30,31
In the field of implant dentistry, 2D as well as 3D models have
been used to analyse the effects of load transfer to the
surrounding tissues as well as on the implant system
itself.25,29,32 Due to limited computing power and resources,
a specific region of interest (ROI) is normally selected for 3D
analysis to allow analysis to be performed on a more detailed
and complex structure. In this study, the ROI covering the left
posterior mandible was reconstructed from the second
premolar up to the second molar. Soft tissues such as the
inferior alveolar nerve, periodontal ligament and pulp were
not modelled due to their limited visibility in CT images.33 The
cement layer was also not modelled because it is physically
similar to that reported in the literature.18,34,35

Micromotion is an important parameter that has received

relatively little attention in the field of prosthodontic implants.
This parameter needs to be addressed for long-term success of
implants as it can predict the primary stability of implants
within the bone and the secondary stability of their components.36,31 Micromotion has been regarded as one of the
parameters that contribute to the formation of microgaps
between the mating surfaces of dental implants.3,11 Occlusal
forces produced during clenching, chewing and jiggling
movements are typically transferred through dental implant
systems, resulting in movement between the implants and the
abutments.32,37
In the present study, a 3D model was used to study the
micromotion of the contacting components under simulated
occlusal loading. In general, different shapes of implant
abutment connections produced different patterns of micromotion. The internal hexagonal and octagonal designs
exhibited micromotion distributions that were similar to that
of the conical design, as the two regular polygonal designs
tend to appear circular with increasing numbers of edges. As
seen in the present study, the edges in a regular polygonal
design act as anti-rotational features that reduce micromotion.38 The pattern of micromotion distribution of the trilobe
abutment was different from those of the other three types of
internal abutments, which could be attributed to its geometry:
polygonal coronally and cylindrical apically. Although the
trilobe produced the lowest micromotion value at the
cylindrical part of the abutment, the polygonal region still
exhibited a high value of micromotion, which could lead to
bacterial penetration at the implantabutment interface.
Additional in vitro studies of micromotion related to the
abutment connection will be conducted to further substantiate our results.
The positional stability of the mating surfaces has been
found to be inversely proportional to rotational freedom.29 The
results of this study show that increasing the number of edges
increases the degree of rotational freedom. In this regard,
internal hexagonal abutments should provide high stability,
followed by internal octagonal, and finally, internal conical
abutments. The internal hexagonal abutment produced the
lowest value of micromotion, followed by the internal
octagonal and internal conical abutments, which demonstrated that the internal hexagonal abutment was the most stable
abutment. The trilobe abutment cannot be categorised as a
regular polygonal form; furthermore, it requires a different
formula to calculate its rotational freedom.29
Tsuge et al.6 analysed five different implant systems with
the cross-sectioning method using a Scanning Electron
Microscope and found that the trilobe shape (Replace Select1)
gave rise to the largest microgap when compared with the
other systems. Harder et al.5 compared two internal conical
connections the Astra Tech1 and the Ankylos1 and found
that the Astra Tech1 prevented endotoxin penetration better
than the Ankylos1. They attributed their results to the
precision fit at the implantabutment interface as a result of
manufacturing tolerance. An in vitro experimental study
conducted by Tesmer et al.39 showed fewer bacterial colony
forming units (CFUs) around the internal conical abutment
than around the trilobe and internal conical (with 0.5 mm
vertical groove) abutments. However, none of these three

journal of dentistry 40 (2012) 467474

reports5,6,39,40 described the application of loading, which is

crucial for the simulation of the actual microgap formation
during mastication.
Static7,13 and dynamic11 loads have been used to analyse the
formation of microgaps at the implantabutment interface.
Zipprich et al.13 analysed ten different implant systems and
concluded that connections with a clearance fit exhibited
micromotion under a static load of 200 N. However, the same
load did not produce any micromotion for precisely conical
connections the Astra Tech1 and the Ankylos1. Another
report7 analysed microgaps under various static loads on a
Straumann AG system and found larger microgaps as the
loading increased. In their dynamic loading experiment,
Steinebrunner et al.11 revealed that the degree of bacterial
penetration was influenced by the applied force, micromovement and precision fit at the implantabutment interface. Loads
of 120 N applied to five different implant systems for 1.2 million
cycles were found to cause bacterial leakage in all the systems.
Apart from the applied loads, the materials of the abutment,
abutment screw and the implant body could also affect the
formation of microgaps. The combination of a zirconia abutment
with a titanium implant body has been shown to produce a larger
microgap when compared with the combination of a titanium
abutment and a titanium implant body.41 Titanium abutments
have also been reported to reduce the occurrence of screw
loosening when compared with gold abutment screws.38
EQV analysis showed different patterns of stress distribution
for different abutment connections. Higher stress concentration was observed around the implant which was engaged at
the level of the cancellous-cortical and cortical-mucosa. EQV
was also found to be concentrated at the edges of internal
hexagonal, internal octagonal and trilobe connections, which
may be attributed to the geometric discontinuities of the
abutment shape.17 Higher stress at the vertices may develop a
higher tendency to crack, causing microfractures,42 and
therefore, microgaps. Microfractures at the trilobe abutment,
especially around the superior region of the implantabutment
connection, may create a window for bacterial penetration.
Even if the stress is not concentrated in the superior region of
the internal hexagonal, internal octagonal and internal conical
abutments, thus preventing bacteria from penetrating through
the interface, it will lead to screw loosening.38
During masticatory function, the microflow of bacteria
from the microgap to the nearest attached mucosa and crestal
bone43 provides a pumping mechanism that may induce the
formation of inflammatory connective tissues around the
dental implant neck,43 thus causing peri-implant mucositis,
and subsequently, peri-implantitis.6,7,9 Healthy connective
tissue consists of different collagen components, such as
collagen I, collagen III, collagen IV and collagen V.44 Collagen
IV is more frequently found in peri-implantitis than in healthy
mucosa, and it has an ability to accelerate bacterial penetration.44 Bibby found that the growth of bacterial flora was more
pronounced around the posterior mandibular teeth, but no
comparison had been made between the lingual and buccal
regions.45 In the present study, EQV was predominantly
compressive around the buccal region of the abutment and
became tensile around the lingual region. This phenomenon
may be attributed to the geometric form of the first molar and
the non-axial loading along the implant axis.32 Such a

473

condition may lead to microgap formation along the lingual

region of the implantabutment interface.

5.

Conclusions

Micromotion between implants and abutments was dependent on the design of the implant connection. Internal
hexagonal and octagonal abutments produced similar patterns of micromotion and stress distribution due to their
regular polygonal design. The internal conical abutment
produced the highest magnitude of micromotion. Unlike the
internal conical abutment, the trilobe abutment produced the
lowest magnitude of micromotion, which was mainly caused
by the polygonal profile. Non-cylindrical abutments showed
lower micromotion, but the tendency of stress to concentrate
at the vertices increased the risk for microfracture, and
therefore for microgap formation.

Acknowledgements
This study was supported by Research Grant No. 03-01-03SF0540 from the Government of Malaysia. An appreciation is
given to Medical Implant Technology Group (MediTeg),
Universiti Teknologi Malaysia and University of Malaya.

references

1. Faggion Jr CM, Giannakopoulos NN, Listl S. How strong is the

evidence for the need to restore posterior bounded
edentulous spaces in adults? Grading the quality of evidence
and the strength of recommendations. Journal of Dentistry
2011;39:10816.
2. Misch CE. Contemporary implant dentistry. 3rd ed. St. Louis:
Mosby Elsevier; 2008.
3. Park IS, Won SY, Bae TS, Song KY, Park CW, Eom TG, et al.
Fatigue characteristics of five types of implantabutment
joint designs. Metals and Materials International 2008;14:133
8.
4. Gomes BPFA, Lilley JD, Drucker DB. Clinical significance of
dental root canal microflora. Journal of Dentistry 1996;24:4755.
5. Harder S, Dimaczek B, AC
il Y, Terheyden H, Freitag Wolf S,
Kern M. Molecular leakage at implantabutment connection
in vitro investigation of tightness of internal conical
implantabutment connections against endotoxin
penetration. Clinical Oral Investigations 2010;14:42732.
6. Tsuge T, Hagiwara Y, Matsumura H. Marginal fit and
microgaps of implantabutment interface with internal antirotation configuration. Dental Materials Journal 2008;27:2934.
7. Rack A, Rack T, Stiller M, Riesemeier H, Zabler S, Nelson K. In
vitro synchrotron-based radiography of micro-gap formation
at the implantabutment interface of two-piece dental
implants. Journal of Synchrotron Radiation 2010;17:28994.
8. Proff P, Steinmetz I, Bayerlein T, Dietze S, Fanghanel J,
Gedrange T. Bacterial colonisation of interior implant threads
with and without sealing. Folia Morphologica 2006;65:757.
9. Myshin HL, Wiens JP. Factors affecting soft tissue around
dental implants: a review of the literature. Journal of Prosthetic
Dentistry 2005;94:4404.

474

journal of dentistry 40 (2012) 467474

10. Faggion Jr CM, Listl S, Tu YK. Assessment of endpoints in

studies on peri-implantitis treatmenta systematic review.
Journal of Dentistry 2010;38:44350.
11. Steinebrunner L, Wolfart S, Bobmann K, Kern M. In vitro
evaluation of bacterial leakage along the implantabutment
interface of different implant systems. International Journal of
Oral & Maxillofacial Implants 2005;20:87581.
12. Shareef N, Levine D. Effect of manufacturing tolerances on
the micromotion at the Morse taper interface in modular
hip implants using the finite element technique. Biomaterials
1996;17:62330.
13. Zipprich H, Weigl P, Lange B, Lauer HC. Micromovements at
the implantabutment interface: measurement, causes, and
consequences. Implantologie 2007;15:3146.
14. Segundo RM, Oshima HM, da Silva IN, Burnett Jr LH, Mota
EG, Silva LL. Stress distribution of an internal connection
implant prostheses set: a 3D finite element analysis.
Stomatologija Baltic Dental and Maxillofacial Journal 2009;11:
559.
15. Segundo RM, Oshima HM, Silva IN, Junior LH, Mota EG,
Coelho LF. Stress distribution on external hexagon implant
system using 3D finite element analysis. Acta Odontolol
Latinoamericana 2007;20:7981.
16. Giannetopoulos S, van Noort R, Tsitrou E. Evaluation of the
marginal integrity of ceramic copings with different
marginal angles using two different CAD/CAM systems.
Journal of Dentistry 2010;38:9806.
17. Faegh S, Muftu S. Load transfer along the bonedental
implant interface. Journal of Biomechanics 2010;43:176170.
18. Kong L, Zhao Y, Hu K, Li D, Zhou H, Wu Z, et al. Selection of
the implant thread pitch for optimal biomechanical
properties: a three-dimensional finite element analysis.
Advances in Engineering Software 2009;40:4748.
19. Muller HP, Schaller N, Eger T. Ultrasonic determination of
thickness of masticatory mucosa: a methodologic study.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and
Endodontics 1999;88:24853.
20. Rho JY, Ashman RB, Turner CH. Youngs modulus of
trabecular and cortical bone material: ultrasonic and
microtensile measurements. Journal of Biomechanics
1993;26:1119.
21. Cheng YY, Cheung WL, Chow TW. Strain analysis of
maxillary complete denture with three-dimensional finite
element method. The Journal of Prosthetic Dentistry
2010;103:30918.
22. Rizkalla AS, Jones DW. Indentation fracture toughness and
dynamic elastic moduli for commercial feldspathic dental
porcelain materials. Dental Materials 2004;20:198206.
23. Rees JS, Jacobsen PH. The elastic moduli of enamel and
dentine. Clinical Materials 1993;14:359.
24. Niinomi M. Mechanical properties of biomedical titanium
alloys. Materials Science and Engineering A 1998;243:2316.
25. Lin CL, Kuo YC, Lin TS. Effects of dental implant length and
bone quality on biomechanical responses in bone around
implants: a 3-D non-linear finite element analysis.
Biomedical Engineering Applications Basis and Communications
2005;17:449.
26. Elias CN, Lima JHC, Valiev R, Meyers MA. Biomedical
applications of titanium and its alloys. Jom Journal of the
Minerals Metals and Materials Society 2008;60:469.
27. Bakke M. Bite force and occlusion. Seminars in Orthodontics
2006;12:1206.
28. Lin CL, Chang CH, Cheng CS, Wang CH, Lee HE. Automatic
finite element mesh generation for maxillary second
premolar. Computer Methods and Programs in Biomedicine
1999;59:18795.

29. Semper W, Kraft S, Kruger T, Nelson K. Theoretical

considerations: implant positional index design. Journal of
Dental Research 2009;88:72530.
30. De Tolla DH, Andreana S, Patra A, Buhite R, Comella B. The
role of the finite element model in dental implants. Journal of
Oral Implantology 2000;26:7781.
31. Abdul Kadir MR, Hansen U, Klabunde R, Lucas D, Amis A.
Finite element modelling of primary hip stem stability:
the effect of interference fit. Journal of Biomechanics
2008;41:58794.
32. Eskitascioglu G, Usumez A, Sevimay M, Soykan E, Unsal E.
The influence of occlusal loading location on stresses
transferred to implant-supported prostheses and
supporting bone: a three-dimensional finite element study.
Journal of Prosthetic Dentistry 2004;91:14450.
.,
33. Zachrisson H, Engstrom E, Engvall J, Wigstrom L, Smedby O
Persson A. Soft tissue discrimination ex vivo by dual energy
computed tomography. European Journal of Radiology
2010;75:e1248.
34. Van Staden RC, Guan H, Loo YC, Johnson NW, Meredith N.
Stress evaluation of dental implant wall thickness using
numerical techniques. Applied Osseointegration Research
2008;6:3947.
35. Van Staden RC, Guan H, Loo YC, Johnson NW, Nell M.
Comparative analysis of internal and external hex crown
connection systems a finite element study. Journal of
Biomedical Science and Engineering 2008;1:104.
36. Cehreli M, Sahin S, Akca K. Role of mechanical environment
and implant design on bone tissue differentiation: current
knowledge and future contexts. Journal of Dentistry
2004;32:12332.
37. Clark GT, Tsukiyama Y, Baba K, Watanabe T. Sixty-eight
years of experimental occlusal interference studies: what
have we learned? The Journal of Prosthetic Dentistry
1999;82:70413.
38. Tsuge T, Hagiwara Y. Influence of lateral-oblique cyclic
loading on abutment screw loosening of internal and
external hexagon implants. Dental Materials Journal
2009;28:37381.
39. Tesmer M, Wallet S, Koutouzis T, Lundgren T. Bacterial
colonization of the dental implant fixtureabutment
interface: an in vitro study. Journal of Periodontology
2009;80:19917.
40. Harder S, Dimaczek B, AC
il Y, Terheyden H, Freitag Wolf
S, Kern M. Molecular leakage at implantabutment
connection in vitro investigation of tightness of
internal conical implantabutment connections against
endotoxin penetration. Clinical Oral Investigations
2009;14:42732.
41. Grunder U, Spielmann HP, Snetivy D. Development, in vitro
testing, and clinical use of a 3.5 mm-diameter zirconia
abutment. The European Journal of Esthetic Dentistry
2010;5:15870.
42. Souiyah M, Muchtar A, Alshoaibi A, Ariffin AK. Finite element
analysis of the crack propagation for solid materials. American
Journal of Applied Sciences 2009;6:1396402.
43. Hagiwara Y. Does platform switching really prevent crestal
bone loss around implants? Japanese Dental Science Review
2010;46:12231.
44. Borsani E, Salgarello S, Mensi M, Boninsegna R, Stacchiotti
A, Rezzani R, et al. Histochemical and
immunohistochemical evaluation of gingival collagen and
metalloproteinases in peri-implantitis. Acta Histochemica
2005;107:23140.
45. Bibby BG. The bacterial flora in different parts of the mouth.
Journal of Dental Research 1938;17:4716.