Effect of Different Framework Materials in

Implant-Supported Fixed Mandibular Prostheses:

A Finite Element Analysis
Diego Sirandoni, DDS1/Eduardo Leal, Eng, MSc2/Benjamin Weber, DDS, MSc3/
Pedro Yoshito Noritomi, Eng, MSc, PhD4/Ramón Fuentes, DDS, DMD3/Eduardo Borie, DDS, MSc, PhD3

Purpose: To evaluate the biomechanical behaviors of different framework materials in implant-supported

fixed mandibular prostheses using three-dimensional (3D) finite element analysis. Materials and Methods:
A model of a severely resorbed edentulous mandible was obtained from a tomography database. Morse
taper–connection implants and multi-unit abutments were cut with an electro-erosion machine and scanned
using a 3D scanner. The implants were positioned on the model at the bone level and distributed equally to
support a fixed complete prosthesis. The simulations were divided into six groups according to the framework
material: titanium (Ti); cobalt-chromium (Co-Cr); zirconia (ZrO2); polyether ether ketone (PEEK); carbon fiber–
reinforced polyether ether ketone (CFR-PEEK); and polymethyl methacrylate (PMMA). The resultant load
applied was obtained from the masseter, temporal, lateral, and medial pterygoid muscles. The principal
stresses and von Mises equivalent stresses were analyzed and compared among the framework materials,
and the results were described both quantitatively and qualitatively. Results: PEEK and PMMA frameworks
showed the highest total deformation values, showing decreases of von Mises stresses in the frameworks,
implants, and abutments, but with a high tensile stress in the trabecular bone that achieved critical values.
CFR-PEEK frameworks achieved their failure limit, whereas the ZrO2, Co-Cr, and Ti frameworks exhibited
principal stresses in the bone region within physiologic limits. Conclusion: From a biomechanical point of
view, the Ti, Co-Cr, and ZrO2 frameworks demonstrated the most favorable outcomes. Int J Oral Maxillofac
Implants 2019;34:e107–e114. doi: 10.11607/jomi.7255

Keywords: biomechanics, dental prosthesis, finite element analysis, implant-assisted

Implant-supported fixed mandibular prostheses on

four or more implants is a successful treatment with a
high survival rate in edentulous mandibles.1,2 However,
In this context, the framework of the prosthesis and its
geometry influence the distribution of stress in the
peri-implant bone.5 The function of the framework in
to achieve long-term success of an implant-supported this type of treatment is to splint the implants together
prosthesis, it is necessary to understand the basic bio- for support, allowing an equal stress distribution from
mechanical concepts of implantology to avoid over- the framework to the implants.6
loading of the bone and consequent implant failure.2–4 For implant-supported prostheses, some authors6–9
have proposed the replacement of rigid frameworks—
such as titanium (Ti), cobalt-chromium (Co-Cr), and
1Master in Dental Sciences Program, Department of Dentistry, zirconia (ZrO2), which have high elastic moduli10—
Dental School, Universidad de La Frontera, Temuco, Chile. with polymeric frameworks milled using computer-
2Mechanical Engineering Department, Universidad de La

Frontera, Temuco, Chile.

aided design/computer-assisted manufacturing (CAD/
3CICO Research Centre, Dental School, Universidad de La CAM), such as polyether ether ketone (PEEK) and
Frontera, Temuco, Chile. fiber-reinforced resin, as these materials have several
4Renato Archer Information Technology Center, Campinas, SP,
advantages such as low cost, light weight, and shock
Brazil. absorbency. In addition, some research has shown that
Correspondence to: Dr Eduardo Borie, Echevarría Av. Francisco materials with high elastic moduli, such as stiff or non-
Salazar 01145, PC: 4811230, Universidad de La Frontera, polymeric frameworks, are not shock absorbing and
Temuco - Chile. Email: [email protected] therefore transmit more stress to the bone-implant
interface.11,12 Zoidis8 stated that using a combination
Submitted June 26, 2018; accepted June 16, 2019.
of two materials with low elastic moduli can dampen
©2019 by Quintessence Publishing Co Inc. occlusal forces by acting as a stress breaker, thereby

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Sirandoni et al

Table 1   Mechanical Properties of the Materials

Material Young’s modulus (GPa) Poisson ratio Ultimate strength (MPa)
Cortical bone  1422 0.322 100–13023
Trabecular bone   1.422 0.322 524
Titanium 11525 0.3525 96026
Co-Cr 21827 0.3327 65526
Zirconia 20025 0.3125 82026
PEEK   4.128 0.428 8029
CFR-PEEK  1528 0.3528 12029
PMMA   330 0.38 30 48 31
Heat-cured acrylic resin   3.232 0.3632 48 31
Co-Cr = cobalt-chromium; PEEK = polyether ether ketone; CFR-PEEK = carbon fiber–reinforced PEEK; PMMA = polymethyl methacrylate.

reducing the stress distributed to the implant and bone. machine (FW 1U, AgieCharmilles, GF Machining Solu-
However, several study findings support the use of a tions). The implant and abutment surfaces were opaci-
rigid framework with single or multiple implants to fied with penetrant ink (Spotcheck SKL-SP2 Penetrant,
achieve better stress distribution and reduce the stress- Magnaflux) to ensure accurate recording of details,
es that may overload the peri-implant bone.13–16 and the geometry of each component was captured
There is limited information about the biomechani- with a 3D scanner (Capture Mini, 3D Systems). Later on,
cal behaviors of polymeric and nonpolymeric frame- the external threads of the implant were modified with
works in implant-supported fixed prostheses and their the Rhinoceros software to simplify the model and the
possible influence on stress distribution in the peri- subsequent analysis.
implant bone, which is critical for the long-term success On the 3D model, the implants were positioned at
of implants.3,17 In this context, finite element analysis bone level and equidistantly to support a fixed com-
(FEA) is a powerful tool for studying the biomechani- plete prosthesis. The mucosa was not considered in
cal behaviors of complex geometries as an initial ap- the model because its influence on the distribution
proach18,19 and may provide information that is still not of stress in the peri-implant bone is minor. The simu-
clinically available.18 Thus, the aim of this study was to lations were divided into six groups according to the
evaluate, through a three-dimensional (3D) FEA, the type of framework used: Ti, Co-Cr, ZrO2, PEEK, carbon
biomechanical behaviors of different framework mate- fiber–reinforced PEEK (CFR-PEEK), and polymethyl
rials in implant-supported fixed mandibular prostheses. methacrylate (PMMA).
The model simulation was performed by export-
ing the framework models into FEA software (v.18.0,
MATERIALS AND METHODS Ansys), and the analyzed structures were considered
to be isotropic, homogenous, and linearly elastic. The
An image of an edentulous mandible was obtained modulus of elasticity, Poisson coefficient, and ultimate
from a tomography database (CTI) and transferred to a strength of each material used in this study were ob-
3D model using InVesalius software (v.3.0, CTI) to simu- tained from the literature (Table 1).
late natural anatomical parameters. The 3D model was The refinement of mesh was mainly performed at
exported to Rhinoceros software (v.5.0, McNeel North the bone-implant interface and over the implants and
America) for simplification and delimitation of the abutments. The numbers of nodes and elements used
main anatomy. were in the range of 535.707 to 1.052.718 and from
The resorption of the mandible was hand modeled 376.720 to 644.987, respectively. All of the implants
to Class VI of the Cawood and Howell classification,20 were considered completely osseointegrated, and
which represents the highest degree of mandibular re- the abutments were fixed to the implants simulating
sorption and evident loss of the basal bone. The height a perfect adaptation characteristic of a Morse taper
of the resorbed mandible used was 12 mm, and a corti- connection.
cal bone thickness of 1 mm surrounding the trabecular The trabecular–cortical bone, implant-bone,
bone was designed to simulate Type III bone according implant-abutment, and framework-prosthesis junc-
to the Lekholm and Zarb classification.21 tions were considered as bonded. However, the
Morse taper–connection implants (Alvim CM abutment-framework junction was simulated using a
3.5 × 8 mm, Neodent) and multi-unit abutments (Mini friction coefficient of 0.2,33,34 which required a nonlin-
Pilar CM, Neodent) were cut with an electro-erosion ear approach for analysis.

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 Sirandoni et al

Table 2   Cosines of the Load Directions and Their Magnitudes on Each Masticatory Muscle
Considered in the Simulation (Right Side36)
Muscle Cos (α) Cos (β) Cos (γ) Magnitude (N)
Masseter –0.043 –0.011 0.999 59.23
Temporal –0.325 0.219 0.920 34.09
Medial pt. 0.587 –0.165 0.792 39.60
Lateral pt. 0.714 –0.692 0.106 34.44

Table 3   Total Deformation and Stress Values for Each Framework Material in the Models Simulated
Maximum Minimum
Total Maximum Minimum principal principal Von Mises Von Mises Von Mises
deformation principal principal framework framework framework implants abutments
Materials (mm) bone (MPa) bone (MPa) (MPa) (MPa) (MPa) (MPa) (MPa)
Co-Cr 0.084 9.5 –19 – – 328 154 160
Titanium 0.085 3.7 –22 – – 262 149 158
Zirconia 0.084 9.5 –21 140 –309 – 180 177
PEEK 0.088 13.9* –18 15.8 –53 – 42.3 46.7
CFR-PEEK 0.084 6.2 –20 a a – 201 173
PMMA 0.089 14.4* –16.5 13 –53.5 – 43.2 39.5
Stresses observed at the trabecular bone.
Co-Cr = cobalt-chromium; PEEK = polyether ether ketone; CFR-PEEK = carbon fiber–reinforced polyether ether ketone; PMMA = polymethyl
methacrylate.
aFailure limit.

A framework of 5.1-mm width and 3-mm thickness applying the boundary condition of compression-only
was hand modeled and placed 2 mm over the alveolar support) and allowing free movements in all other di-
ridge, with a cantilever length of 10 mm from the distal- rections. It was necessary to define this limiting condi-
most implants. The complete prosthesis was also hand tion to prevent the rotation of the model as a whole.39
modeled, and the position of each prosthetic tooth was In this way, the same restrictive condition was estab-
determined based on a study by Salles et al35 and fabri- lished for the molar, premolar, and canine regions in
cated using Ivoclar’s stock teeth set (Ivoclar Vivadent AG). the occlusal plane of the prosthesis on the models, with
The prosthesis was designed up to the first molar free movements in the horizontal plane but restricted at
with an extension of 2 mm posterior to the framework. compression in the vertical direction.39
The occlusal surface of the prosthesis was modeled The total deformation of each model was assessed
with an overlapped image of the Curve of Spee to en- and compared to check whether the values were
sure that it followed the same occlusal slope. within the normal parameters. Further, the implants,
To assess the physiologic and biomechanical be- abutments, and frameworks made from Co-Cr and
haviors of the model, a resultant load value was ob- Ti were studied according to von Mises equivalent
tained from the masseter, temporal, lateral, and medial stress analysis, which is suitable for ductile materials.
pterygoid muscles. The direction and magnitude of The nonductile materials (ZrO2, PEEK, CFR-PEEK, and
the loads were established previously by Cruz et al.36 PMMA) and bone were evaluated using principal stress
The cosines of each muscle were multiplied by their analysis due to their similarity to brittle materials40 and
magnitude (Table 2) to obtain the vectors with their their low tolerance for tensile loads when compared to
respective loads, and then these values were applied compressive loads.38,41,42 All analyses were performed
to the insertion area of each masticatory muscle.37 The using graphic visualization of standardized color maps
loads were considered to be symmetrical to the mid- to compare the models, which were described both
line and equal on both sides of the mandible.38 Thus, quantitatively and qualitatively.
the equivalent load applied over the simulated pros-
thesis was 258 N (26.3 kgf ).
To simulate the chewing movements that occur RESULTS
when the masticatory muscles are in function (Fig 1), the
condyles in the model were restricted to perform only The stress values of each material and the total defor-
compression movements in the upper region (thereby mation of each model are summarized in Table 3.

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Sirandoni et al

implant-supported fixed mandibular prostheses led

B C the authors of this study to evaluate the biomechani-
G cal behaviors of different materials used in framework
H
fabrication using FEA as an initial analytic approach.
E Some studies10,43,44 have evaluated the effect of frame-
F I work materials in implant-supported fixed mandibular
J prostheses; however, the present research is the first to
D compare the effect of three types of polymeric frame-
A
work materials and those of three nonpolymeric types.
The results indicate that nonpolymeric materials (Ti,
Co-Cr, and ZrO2) showed the most favorable outcomes
related to stress distribution in the peri-implant region.
Regarding the region of stress concentration, all
models showed that the distal-most implants and
abutments concentrated more stress, a finding concur-
Fig 1   Boundary conditions (blue) and loads (red) for each mas- rent with previous studies.22,45 This can be explained
ticatory muscle in the simulated models. A–D: masseter; B–C: by the biomechanics of a Class 1 lever model with
condyles; F–H: temporal; G–H: lateral pterygoid; J–I: medial its fulcrum located at the distal-most implants.46 In
pterygoid.
the case of polymeric materials (CFR-PEEK, PEEK, and
PMMA), their low elastic moduli could lead to a longer
When considering the total deformation of the lever arm due to greater deformation in these models.
models, the frameworks simulated in PMMA and PEEK This could lead to higher stress on the distal-most im-
showed the highest values. plants when functional loads are applied, as has been
The highest maximum principal stress values in the reported previously.14 In this sense, a rigid framework
trabecular bone region were observed in the models can help improve the stress distribution.46,47
with PEEK and PMMA frameworks at the distal-most Despite the fact that some studies have reported a
implants. The lowest maximum principal or tensile cushioning effect of polymeric materials on stress dis-
stress was observed in the Ti framework model in the tribution in the peri-implant region,48,49 in this research,
external cortical region of the distal-most implants it was found that a decrease in stress occurred in the
(Fig 2); however, the Ti framework showed the high- framework and an increase occurred in the trabecular
est minimum principal or compressive stress in the bone region. This could be related to the absence of a
cortical bone, while the lowest compressive stress was stiff framework50 in conjunction with the high flexibil-
noted in the PMMA model. ity of the material.47 Specifically, the models simulated
Regarding the von Mises equivalent stress in the in frameworks of PEEK and PMMA showed a high stress
implants, the highest stress values were identified in concentration of approximately 13 to 14 MPa in the
the models with CFR-PEEK, while the lowest were ob- trabecular bone region. These values are critical when
served in PEEK and PMMA models (Fig 3). In the abut- considering framework material because it has been
ments, the highest von Mises equivalent stress was reported that a stress concentration value > 5 MPa may
noted in the model with ZrO2 related to the distal-most cause an overload of trabecular bone,24 consequently
implants, while the lowest stresses were identified in leading to bone resorption. The highest values of total
the models with PEEK and PMMA in the same location. deformation were observed in both PEEK and PMMA,
Within the ductile frameworks, the highest von which behaved biomechanically in less rigid models;
Mises stress was observed in the Co-Cr model at the in contrast, the models of Ti, ZrO2, and Co-Cr frame-
joint with the distal abutments. In the case of nonduc- works did not show critical stress values in the trabecu-
tile materials, the highest principal stress values were lar bone region, and stresses observed in the cortical
also observed in the framework made in ZrO2 at the bone were within physiologic limits with a wide margin
joint with the distal abutment (Fig 4). The stress values of security (considering the tensile stress range of corti-
in the framework simulated in CFR-PEEK achieved its cal bone is 100 to 130 MPa and the compressive stress
failure limit. range is 170 to 190 MPa23). Despite the analysis of this
study being static, which may involve 10% to 20% less
stress than a dynamic analysis, these values would still
DISCUSSION fall within the physiologic range.
The stress values of nonpolymeric materials were
The emergence of different opinions on the use within a security margin of 50% of the failure limit of
of polymeric vs nonpolymeric frameworks in each material (Table 1). The Co-Cr framework showed

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Fig 2  Maximum principal

MPa MPa
stresses in the bone region
exerted by the frameworks. 17.818 9.534
(a) Titanium. (b) Cobalt 10.000 8.3423
chromium. (c) Polyether
8.5714 7.1505
ether ketone. (d) Polymethyl
methacrylate. 7.1429 5.9588
5.7143 4.767
4.2857 3.5753
2.8571 2.3835
1.4286 1.1918
0 0
–13.25 –13.209
a b
MPa MPa
14.387 14.362
10.000 10.000
8.5714 8.5714
7.1429 7.1429
5.7143 5.7143
4.2857 4.2857
2.8571 2.8571
1.4286 1.4286
0 0
–13.25 –13.25
c d

Fig 3  von Mises equiva-

MPa MPa
lent stresses at the im-
plant region in the models 383.91 293.03
with ductile and nonductile 100.00 150.00
frameworks. (a) Titanium.
87.513 131.26
(b) Cobalt chromium. (c)
Polyether ether ketone. (d) 75.026 112.52
Polymethyl methacrylate. 62.539 93.782

50.052 75.043

37.564 56.304

25.077 37.565

12.59 18.825

0.1032 0.0862

a b
MPa MPa
42.289 43.257
37.597 38.459
32.906 33.66
28.215 28.862
23.523 24.063
18.832 19.264
14.141 14.466
9.4494 9.6674
4.758 4.8689
0.0667 0.0703
c d

stress values of about 50% of the failure limit, while strength were observed for PMMA and PEEK, respec-
those for Ti and ZrO2 frameworks were 27% and 17% of tively. Furthermore, the computed stress values in the
the failure limit, respectively. In the case of polymeric abutments and implants of the polymeric frameworks
materials, with the exception of CFR-PEEK, security were approximately 5% of the failure limits of Ti, while
margins of approximately 27% and 20% of the ultimate in the nonpolymeric frameworks they were about 16%.

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MPa MPa Fig 4  Stresses at the

663.91
framework region in differ-
752.73
ent models. (a) Titanium.
262.00 300 (b) Cobalt chromium. (c)
229.26 262.51 Polyether ether ketone. (d)
196.51
Polymethyl methacrylate.
225.01
163.77 187.52
131.02 150.02
98.279 112.53
65.535 75.034
32.791 37.54

0.0465 0.0451
a b
MPa MPa

27.343 46.468

15.8 13

13.543 11.375

11.286 9.7501

9.0286 8.1252

6.7714 6.5003

4.5143 4.8754

2.2571 3.2504

0 1.6255

–6.2482 0.0005
c d

It is important to note that the nonpolymeric ma- for such treatment due to their low wear resistance
terials showed more stress concentration in the frame- and high mechanical failure rates. Also, Sarot et al54
works, abutments, and implants—structures that can compared the stress distributions between CFR-PEEK
withstand more stress51—while the polymeric materi- dental implants and Ti implants, identifying no biome-
als exhibited a low stress concentration in these struc- chanical advantages of CFR-PEEK over Ti implants.
tures and higher stress concentration in critical regions Arinc55 recently used FEA to study the “cushion
such as the trabecular bone. Thus, in this FEA, the effec- effect” of PMMA, in which the influence of zirconia-
tiveness of the cushion effect of the polymeric materi- reinforced PMMA on the distribution of stress in an
als simulated as frameworks was low and limited only implant-supported fixed partial prosthesis was ana-
to compressive stress, concurring with the study by Lee lyzed. The lowest stress values were identified in the
et al,14 who evaluated PEEK as a framework material. As framework that showed an increase in stress values in
such, there are two reports6,8 of PEEK as a framework the bone, which is in accordance with the results of
material in implant-supported fixed complete prosthe- this study.
ses, but both have a short-term follow-up of no more Although this FEA methodology is widely used as
than 2 years. Additionally, both the authors6,8 accepted an initial approach to evaluate dental implants in dif-
that this material still requires long-term validation. In ferent scenarios, these findings should be interpreted
addition, a recent review of PEEK properties in prosth- with caution. The limitations of this study include the
odontics52 concluded that there is not enough infor- assumptions of complete osseointegration of implants
mation about the mechanical properties and potential and of the trabecular bone as a homogenous body and
complications of this material and it is therefore still that the simulation was based on a static analysis. How-
not recommended. ever, these simplifications were necessary considering
The CFR-PEEK framework model achieved the failure the computational limitations. Analytical results from
limit of this material during the simulation. Although finite element models primarily depend on the accuracy
this research is based on a computed biomechani- of the models developed; thus, these models must be as
cal simulation, this would be potentially unfavorable similar as possible to reality.56 This study tried to simu-
if the material behaves similarly in a clinical scenario. late the chewing movements in realistic conditions of
In a recent study53 in which PEEK and CFR-PEEK were the craniomandibular system. The novelty of this study
compared in cases of total knee replacement, it was was that the load applied in simulation was the result of
concluded that neither of these materials are indicated masticatory muscle vectors each with proper magnitude

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 Sirandoni et al

and direction, according to the studies of Hannam57 and 3. Borie E, Orsi IA, de Araujo CP. The influence of the connection,
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