ISSN 0103-6440

Brazilian Dental Journal (2014) 25(6): 554-560

http://dx.doi.org/10.1590/0103-6440201300144

E f f e c t o f t h e Pa r a f u n c t i o n a l
Occlusal Loading and Crown
Height on Stress Distribution
Leonardo Bueno Torcato, Eduardo Piza Pellizzer, Fellippo Ramos Verri, Rosse
Mary Falcn-Antenucci, Victor Eduardo de Souza Batista, Leonardo Ferreira
de Toledo Piza Lopes.

The aim of this study was to assess, by the three-dimensional finite element method,
the influence of crown-to-implant ratio and parafunctional occlusal loading on stress
distribution in single external hexagon implant-supported prosthesis. Computer-aided
design software was used to confection three models. Each model was composed of a
block bone and an external hexagon implant (5x10.0 mm) with screw-retained implant
prostheses, varying the height crown: 10, 12.5 and 15 mm. Finite element analysis
software was used to generate the finite element mesh and to establish the loading and
boundary conditions. Normal (200 N axial and 100 N oblique load) and parafunctional
forces (1,000 N axial and 500 N oblique load) were applied. The results were visualized
by von Mises and maximum principal stress. In comparison with the normal occlusal
force, the parafunctional occlusal force induced an increase in stress concentration and
magnitude on implant (platform and first threads) and screw (neck). The cortical bone
showed the highest tensile stress under parafunctional force (oblique load). The stress
concentration increased as the crown height increased. It was concluded that: increasing
the C/I increased stress concentration in both implant components and cortical bone;
parafunctional loading increased between 4-5 times the value of stresses in bone tissue
compared with functional loading; the type of loading variation factor is more influential
than the crown-to-implant factor.

Introduction

The use of osseointegrated dental implants for replacing

teeth is a viable option, especially in the restoration of single
edentulous spaces. Despite the high rates of success and
survival, the implant supported prostheses are still subjected
to biological and biomechanical complications (1).
Occlusal overload, unfavorable crown-to-implant ratio
(C/I), cantilevers, the size of occlusal table and non-axial
loads are some of the prosthetic factors that often involve
dental implant failures. So, from a biomechanical point
of view, an adequate transfer of occlusal loads to bone
tissue through the components is very important for the
prosthesis success (2).
According to Laney (3), C/I refers to the relation between
restoration height and length of the implant incorporated
into bone tissue. Differently from natural teeth, two types
of C/I can be defined: anatomic C/I, where the lever arm
fulcrum is located in the region of implant/abutment
interface, and clinical C/I, located in the area of bone/
implant contact (4).
Clinically, bone resorption presents two serious
challenges for Implantology: the absence of enough bone
tissue for implant placement and a subsequent alteration
of occlusal vertical dimension, which is typically associated

Department of Dental Materials and

Prosthodontics, Araatuba Dental
School, UNESP - Univ Estadual
Paulista, Araatuba, SP, Brazil
Correspondence: Rosse Mary FalcnAntenucci, Rua Jos Bonifcio 1193,
Vila Mendona, 16015-050 Araatuba,
SP, Brasil. Tel.: +55-18-3636-3297.
e-mail: [email protected]

Key Words: finite element

analysis, implant-supported
prostheses, parafunctional load.

with cosmetic problems. It leads to the use of shorter

implants due to absorption or use of higher crowns,
which alters the crown/root ratio associated with natural
dentition (5). Although C/Is between 0.5 and 1 have been
proposed to prevent stresses in peri-implant region and
the consequent bone loss, as well as any implant failure,
no clinical protocol has been established yet (6).
Thus, the use of short implants in association with
atrophic jaw has been considered a risk factor because
of the increased maxillary-mandibular relation, where
installation of higher crowns is required, which favors the
emergence of an unfavorable crown/implant proportion
(7). This unfavorable proportion can result in excessive nonaxial loads that increase the likelihood of force moments
and stresses on prosthetic components and bone tissue
from peri-implant cervical region (6).
Complications such as loosening of the crown retaining
screw, fracture of prosthetic components, cervical bone
loss, and microdeformations (between 2,000 and 3,000
microstrain) or microfractures (above 4,000 microstrain)
in bone/implant interface reported in animal and human
model studies, are some consequences of implant
overloading (8). However, it should be noted that the
maximum occlusal force applied and tolerated varies greatly

Braz Dent J 25(6) 2014

Materials and Methods

Three models were created. Each model was composed

of a mandibular molar bone block (cortical and trabecular),
one external hexagon implant (5x10 mm) (Master Screw;
Conexo Sistema de Prtese Ltda., Aruj, SP, Brazil) and a
screw-retained single crown.

Model Design
The external hexagon implant and UCLA abutment
geometries were used as reference to create the 3D
design. These images were simplified by SolidWorks 2010
(SolidWorks Corp, Waltham, MA, USA) and Rhinoceros 4.0
softwares (NURBS modeling for Windows; Robert McNeel
& Associates, Seattle, WA, USA).
A screw-retained single crown was simulated using a 20
cusp inclination. The crown framework was fabricated from
nickel-chromium alloy and feldspathic porcelain was used
as veneering material like porcelain-fused-to-metal dental
crown. The crown design was obtained from an artificial
mandibular molar tooth (Odontofix Indstria e Comrcio
de Material Odontolgico Ltda., Ribeiro Preto, SP, Brazil),
and digitized using a 3D scanner (MDX-20; Roland DG, So
Paulo SP, Brazil). The images were exported to Rhinoceros
4.0 CAD software for modeling and occlusal surface details

were added using SolidWorks CAD software. The simulated

crown heights were: 10, 12.5 and 15 mm (12).
The bone block was obtained by a CT scan arrangement
using InVesalius software (CTI Renato Archer, Campinas, SP,
Brazil) and it was simplified by Rhinoceros 4.0 software.

Material Properties, Loading and Boundary Conditions

After the modeling phase, all geometries were exported
to finite element software (FEMAP 10.2; Siemens PLM
Software Inc., Plano, TX, USA) for pre and post-processing.
The first step was to obtain the meshes using tetrahedral
parabolic solid elements for all the structures involved.
The models had 268,880 elements and 407,172 nodes in
model A, 334,590 elements and 503,816 nodes in model
B and 482,920 elements and 318,929 nodes in model C.
The mechanical properties, such as elastic modulus and
Poissons coefficient of each material, were incorporated
according to the values obtained in literature (13-16), as
shown in Table 1. All materials were considered isotropic,
linearly elastic and homogeneous.
The crown/abutment and abutment/implant contacts
were assumed to be symmetric and all other contacts
were assumed to be symmetrically welded. The constraint
definitions were established as fixed in x, y, and z axes at
the mesial and distal boundary surfaces of cortical and
trabecular bone. All other model surfaces were unrestricted.
The load was applied in axial and oblique directions. A
normal occlusal force (200 N axial and 100 N oblique) and
a parafunctional occlusal force (1,000 N axial and 500 N
oblique) were applied on the crowns occlusal surface. The
axial load was distributed into four points on the cusps
internal slope, while the oblique load was divided into two
loading points.
The analysis was generated in FEMAP 10.2 and exported
to processing on NeiNastran 9.2b (Noran Engineering, Inc.,
Westminster, CA, USA) finite element software. Afterwards,
the results were imported to FEMAP 10.2 for von Mises and
maximum principal stress map plotting.

Table 1. Materials properties

Youngs
modulus (GPa)

Poissons
ratio

Reference

Trabecular bone

1.37

0.30

Sevimay et al. (20)

Cortical bone

13.7

0.30

Sertgoz et al. (21)

Titanium

110.0

0.35

Sertgoz et al. (21)

Ni-Cr alloy

206.0

0.33

Anusavice and
Hojjatie (22)

Feldspathic
porcelain

82.8

0.35

Eraslan et al. (23)

Material

555

Effect of parafunctional load and crown height

according to implant position in the arch, functional and/

or parafunctional (bruxism) habits, as well as the nature
of antagonist teeth (9).
Some authors have suggested that the influence of
occlusal overload originated from parafunctional habits,
such as bruxism over dental implants and their components
provides a greater risk of biological and biomechanical
complications in comparison with physiological chewing
activities (10). However, according to Lobbezoo (11), there
are still no scientific evidences about this subject. Within
this context of clinical studies, the author shows that the
cause/effect relationship between bruxism and implant loss
is not enough, since the criteria used to validate the causeeffect relationship are not present in the articles evaluated
in this review. Therefore, due to the lack of studies that
clarify this relation, the three-dimensional finite element
method can be used as an alternative for the evaluation
and prediction of areas with greater potential for failures
in the bone-implant-crown set.
The purpose of this study was to assess, by a threedimensional finite element method, the influence of C/I
and parafunctional occlusal loading on stress distribution
in single external hexagon implant-supported prosthesis.
The hypotheses of the study were: i) Parafunctional loading
will induce greater stresses on bone-implant-crown set, ii)
The maximum crown height will produce higher stresses
at crown/implant set or bone tissue.

Braz Dent J 25(6) 2014

Criteria Stress Analysis

The von Mises stress analysis was used for implantprosthetic components and implant (ductile materials).
The maximum principal stress value was used as the
evaluation criterion for cortical and trabecular bone (brittle
materials). This criterion offers the possibility of making
a distinction between tensile and compressive stresses.
Positive values represent tensile stress; negative values
represent compressive stresses. The measurement unit in
this study was MegaPascal (MPa).

Results
Implant

L.B. Torcato et al.

Under functional axial loading, stresses were observed

between the platform and first implant thread and on

regions around the screw (2.5 to 3 MPa), for the three models.
However, models B and C exhibited higher stress areas
with the same magnitude (1-3 MPa). Under parafunctional
loading, model A (Fig. 1A) showed stresses in the region of
threads at screw level, while models B and C (Figs. 1B and 1C)
showed a similar pattern of stress distribution. The highest
stresses were between 6.667 and 11.33 MPa.
Under functional oblique loading, all models presented
stress areas located in the hexagon region and implant
platform on the same side of load application and in
the first threads of the contralateral side, and model C
showed the greatest stress areas, between 50-63.33 MPa.
Under parafunctional loading, a high intensity stress
concentration was found in the same areas, but in a greater
area (Figs 1D, 1E and 1F). Model C (Fig. 1E) presented the

Figure 1. von Mises stress of implant under axial load and functional occlusal force - Height crown:(A) 10 mm, (B) 12.5 mm, (C) 15 mm.
von Mises stress of implant under oblique load and parafunctional occlusal force - Height crown: (D) 10 mm, (E) 12.5 mm, (F) 15 mm..
556

Braz Dent J 25(6) 2014

Screw
The stress distribution on the retaining screw was
similar among the three models, both under functional
and parafunctional axial loading. The highest stress was
located in a small area at the level of screw thread (Figs.
2A, 2B and 2C).

Under functional oblique loading, the three models

also exhibited the same stress distribution pattern and the
highest stress was observed in the neck (15-30 MPa) in
model C. Under parafunctional loading, the high intensity
stresses were located in screw neck, on the same side of
load application. The high intensity stress values ranged
from 70 to 113.3 MPa.

Cortical Bone
The pattern of stress distribution was similar among the
three models, both under functional and parafunctional
axial loading (Figs 3A, 3B and 3C), but with different
magnitudes and concentrations. Models A showed the
highest tensile stress (0.167 to 1 MPa and 0.833 to 10
MPa, respectively), while models B and C presented the
most extensive compression stress areas.
Under oblique loading, it must be emphasized that
the progressive increase in crown height (Figs 3D, 3E and
3F), induced not only an increase in tensile stress areas
(25 to 50 MPa), but also in areas of compression stress on
the contralateral side, although on a larger scale under
parafunctional load.

Figure 2. von Mises stress of screw under oblique load and

parafunctional occlusal force. Height crown: (A) 10 mm, (B)
12.5 mm, (C) 15 mm.

Trabecular Bone
In a frontal view, tensile stresses were observed on the

Figure 3. Maximum principal stress of cortical bone under axial load and parafunctional occlusal force - Height crown:(A) 10 mm, (B)
12.5 mm, (C) 15 mm. Maximum principal stress of cortical bone under oblique load and parafunctional occlusal force - Height crown:
(D) 10 mm, (E) 12.5 mm, (F) 15 mm.
557

Effect of parafunctional load and crown height

highest stress concentration. The high intensity stress values

ranged from 113.3 to 200 MPa.

Braz Dent J 25(6) 2014

tip of threads, and the greatest magnitude was located at

the level of first thread under functional (0.417 to 1 MPa)
and parafunctional axial loading (0.833 - 10 MPa). Under
oblique loading, these stresses were concentrated mainly
on the opposite side of load application and showed much
greater magnitude in parafunctional (2.5 to 4.167 MPa)
than in functional loading (0.833 to 1.667 MPa) (Figs. 4A,
4B and 4C).

L.B. Torcato et al.

Discussion

The effect of C/I (C/I) in peri-implant bone tissue was

more evident with the greatest crown height, and stresses
were intensified in all models when parafunctional occlusal
loading was applied, so the study hypothesis was confirmed.
These results were verified by the values of von Mises and
maximum principal stresses which showed unfavorable
results for the variables parafunction and crown height.
In the study, single crowns were used in order to isolate
the studied factor (parafunctional loading and height
crown), because if the crowns were splinted, the splinting
could reduce stress distribution, modifying the results.
The maximum crown height produced a greater stress
concentration, especially under parafunctional occlusal
loading; this may be explained because the crown height
acts as a vertical cantilever at the moment of load incidence.
This was also observed by Misch et al. (12) who suggested
that the crown height represents a potentially more
significant factor related to C/I, where the non-axial forces
are proportionally intensified (for every 1 mm increase,
stresses rise 20%).
Nevertheless, retrospective (6,17-19) and prospective
clinical studies (4,9) and a systematic review (7) evaluated
the effects of biomechanical factors on single and splinted
implant supported prosthesis, and suggested that C/I is not a
contributing factor to the stability of marginal bone tissue,
and is also unrelated to implant or prosthesis failure. The

positive results observed by previous authors could be due

to the use of internal connection associated with splinting
in some cases and with an average C/I of 1.5 (7).
Moreover, other studies based on finite element method
corroborate the evidence of the present study by the fact
that C/I ratio is a biomechanical factor related to stress
concentration at the level of prosthetic components and
marginal bone crest (20,21). These previous findings may
be explained by the high elastic modulus of cortical bone
and its smaller surface contact with dental implant, based
on engineering principles, in which stresses of larger
magnitudes are observed in the region of first contact
between two materials (bone/implant) (22). Because
cortical bone has a smaller thickness and a higher elasticity
modulus than the trabecular bone, it will concentrate
higher stresses due to its low deformation and small area
of stress distribution.
In a systematic review, Naert et al. (23) related that
the potential effects of overload on peri-implant tissue
could be ethically analyzed by animal studies, and very
few clinical studies obtained from the current scientific
literature show high reliability of the obtained data, thus
there is no established relationship of cause and effect
between parafunctional loads and implant failure. Despite
this, Chvartsaid et al. (24) reported the hypothesis of
overload and periimplantitis, in which the marginal bone
loss and implant failure depend on similar mechanisms,
but the occurrence of one or another situation is directly
related to the magnitude of trauma.
Despite the divergences among authors, differences in
stress distribution pattern regarding the loading type and
direction can be explained by the fact that the simulation
of a parafunctional activity (bruxism) associated with nonaxial loads could cause occlusal overload in dental implants,
their components (11) and the adjacent bone tissue, since
the force moments are much higher than those generated

Figure 4. Maximum principal stress of trabecular bone under oblique load and parafunctional occlusal force. Height crown:(A) 10 mm,
(B) 12.5 mm, (C) 15 mm.
558

Braz Dent J 25(6) 2014

Resumo
O objetivo deste estudo foi avaliar, atravs do mtodo dos elementos
finitos tridimensionais, a influncia do carregamento oclusal parafuncional
e da altura da coroa na distribuio das tenses em prteses unitrias
implantossuportadas de hexgono externo. Foram confeccionados trs
modelos com o auxlio de programas de desenho assistido. Cada modelo
foi composto por um bloco sseo da regio molar mandibular, por um
implante de tipo hexgono externo (5x10,0 mm) e por coroa com diferentes
alturas: 10, 12,5 e 15 mm. Os modelos foram exportados para o programa
de elementos finitos NEiNastran 9.0, para gerao das malhas e estabelecer
as condies de contorno. Aplicou-se uma carga funcional (200 N axial
e 100 N oblqua), bem como uma carga parafuncional (1.000 N axial e
500 N oblqua). Os resultados foram visualizados por meio de mapas de
Tenso de von Mises e mapas de Tenso Mxima Principal. O carregamento
parafuncional induziu um aumento da rea de distribuio e da magnitude
das tenses no implante (plataforma e primeiras roscas) e parafuso

(pescoo) em comparao com o carregamento funcional. A cortical

ssea apresentou maiores reas de tenso por trao sob carregamento
parafuncional oblquo. A concentrao de tenses aumentou medida
que aumentou a altura da coroa. O aumento da altura da coroa induziu
um aumento na concentrao de tenses, tanto nos componentes do
implante, quanto na cortical ssea; o carregamento parafuncional induziu
um aumento entre 4-5 vezes da magnitude das tenses no tecido sseo;
o tipo de carregamento apresenta-se como um fator de variao mais
influente do que a proporo coroa/implante.

Acknowledgements
This work was supported by The So Paulo State Research Foundation
(FAPESP - grant #2011/03624-0).

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Effect of parafunctional load and crown height

in a functional activity. In the present study, parafunctional

loading, especially under oblique direction, induced an
increase of approximately 33% of von Mises stress and
60% of Maximum Principal Stress.
Additionally, the parafunctional loading of the implant
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Concerning the complications of external connection,
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The stresses were more intense under parafunctional
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distribution of occlusal forces and minimize the stress in the
supporting structures. In addition, it is recommended that,
at nighttime, the patient uses a hard acrylic interocclusal
appliance with appropriate disocclusion guides.
Based on the used methodology, it was concluded that:
1. Increasing the crown/implant proportion enhanced the
stress concentration on both implant components and
cortical bone; 2. Parafunctional loading increased between
4-5 times the stress magnitude in bone tissue compared to
the functional loading; 3. The type of loading is a variation
factor more influential than the C/I

Braz Dent J 25(6) 2014

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Received July 7, 2014

Accepted November 7, 2014