Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis

Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis Elif Ozturk Bayazit, Nadine von Krockow, Ricardo Curcio This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4544285/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 May, 2026 Read the published version in BMC Oral Health → Version 1 posted 15 You are reading this latest preprint version Abstract Introduction To evaluate the stress distributions of anteriorly placed dental implants in different clinical scenarios including extraction socket or healed bone as well as immediate or late loading. Material and Methods Standard tessellation language (STL) files of original components were used for the in-silico modelling of implant and abutments. The implant was placed into the bone block to imitate three different clinical scenarios including: i. healed bone-delayed loading, ii. healed bone-immediate loading, iii. immediate implant-immediate loading. In all models, both a horizontal force (25.5 N) and a 30-degree oblique force (178 N) were applied to the long axis of the implant to the palatal surface of the restoration. The stress distribution was evaluated. Results The highest stress values in trabecular bone were observed in the clinical scenario where immediate implant was inserted to the extraction socket followed by immediate loading to the healed bone and late loading to the healed bone, respectively. Conclusion The difference in stress distribution is much more evident when the clinical scenario changes, both in values and geometric distributions of stresses, than when the abutment angle changes. Oblique forces create more stress on both the bone and around the implant. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Rebuilding a single lost tooth with precision is a major challenge in reconstructive dentistry, especially in the aesthetic area. When restoring a single lost tooth, there are several restorative options available. Implant-supported crowns are frequently used in the esthetic zone, especially with the development of tooth-colored materials with modern implantology (2). A number of variables, such as implant design, prosthesis material and design, and host features such recipient bone quality, may impact the long-term clinical outcome of implant-supported restorations (3, 4). A good and effective treatment plan requires the clinician to carefully analyze each of these factors (2). Alveolar resorption starts after extraction and can continue for longer than a year (5). Because of its low thickness and decreased blood supply from the periodontal tissues, the buccal bone plate in the maxilla resorbs more quickly than the palatal bone (5–7). In order to facilitate later implant placement in the healed bone, it has been proposed that immediate implant implantation in the extraction socket to decrease bone resorption (8). Immediate loading protocols within physiological limits especially on the esthetic zone is reported to be crucial in order to prevent the existing osseous and gingival architecture (9). However, clinical studies in the literature are contradictory. Moy et al. (10), reported higher success rates when implants were loaded with delay compared to that of immediately loaded. On the other hand, Henningsten et al. (11) reported comparable results between differently loaded anteriorly placed implants. Different results in clinical studies may be due to various reasons, such as differences in methodology. However, there is still a need for in vitro studies examining dental implants in different clinical scenarios to help interpret and predict clinical outcomes. Dental implants' internal geometry is a crucial factor effecting the clinical success as it is responsible for the bacterial infiltration via the implant-abutment interface (12). Therefore, a tight fit between the implant and the prosthetic superstructure is a desirable feature to prevent bacterial invasion. Previous research assessed internal conical connection implants with various internal angles in vitro for this reason. (13, 14). However, evaluating differently angulated abutments in vivo in different clinical scenarios is expensive, difficult, and time consuming. Distribution of stress generated by chewing forces around dental implants is another factor influencing the clinical success (15). One effective technique for assessing the stresses and strains that the forces in the oral environment place on dental implants and the surrounding tissues is to employ finite element analysis (FEA) (16, 17). Moreover, FEA gives dental professionals the chance to comprehend and evaluate implant designs, materials, and their effects on the surrounding osseous structures more quickly, effectively and economically (16, 18, 19). Prior research has used FEA with different methodology to assess the stress accumulation on peripheral bone and implants positioned anteriorly. (15, 20–23). Nevertheless, there is a lack of information in the literature regarding three-dimensional (3D) FEA when different abutment designs used in different clinical scenarios such as immediate or late insertion of dental implants are insufficient in the literature. Therefore, the aim of this study was to evaluate the stress distributions of anteriorly placed single implants in different clinical scenarios including extraction socket or healed bone as well as immediate or late loading. The null hypotheses were tested that, 1. The stress distributions of anterior single implants placed in three different clinical scenarios (i. immediate implant and immediate loading, ii. late implant and immediate loading, iii. late implant and late loading) will be different around bone, implant and abutment, 2. Two different abutment designs (5 and 10 degrees) will not influence the stress distribution around bone, implant and abutment. Materials and Methods On HP workstations with an INTEL Xeon E-2286 processor clocked at 2.40 GHz and 64 GB ECC memory, 3D mesh structure arrangement and its conversion into a mathematically appropriate solid mesh structure, as well as the creation of 3D FEA models, were carried out. Obtaining the .stl model from tomography data was done in a 3D software ( http://www.slicer.org ) (3D Slicer image computing platform. http://www.slicer.org . Accessed 4 July 2023). ANSYS Spaceclaim software was used for reverse engineering and three-dimensional computer-aided design (CAD); ANSYS Workbench software (Ansys Inc., Canonsburg, PA, USA) was used for solid model adaptation to the analysis environment and for creating optimized meshes; the finite element models were solved using the LS-DYNA (LSTC, Livermore, CA, USA) solver. Modelling of Cortical and Trabecular Bone Structures The study's cortical and trabecular bone model was created using CT scan data from an adult patient who was edentulous. Reconstructed tomography data has a 0.1 mm slice thickness. The tomography data was imported in the DICOM (.dcm) format into the 3D Slicer program. Using 3DSlicer software, CT data in the DICOM format was segmented into a three-dimensional model by setting the proper Hounsfield values. A.stl file was used for model export. By adding a 2 mm inner offset to the maxillary bone, a 2 mm thick cortical bone model was produced. By reference to the inside surface of the three-dimensional maxillary cortical bone, trabecular bone was identified. The modeling procedure was finished once all of the ready models were positioned in the proper 3D coordinates using the modeller ANSYS Spaceclaim program. Modelling of Implant, Abutment, Screw, Cement and Prosthesis A titanium bone level implant (Ø: 3.75 mm, 10 mm in height), a zirconium abutment, and a screw were designed and modeled after their respective commercial counterparts (Nobel Paralell Conical Connection) with the same 3D design software. Following that, a prefabricated zirconium abutment was designed over the implant (Ø: 4.35 mm,height: 7 mm, gingival height (GH): 3 mm, finishing line thickness: 0.5 mm). Esthetic abutments with two different emergence profiles of 5 degrees and 10 degrees were designed according to the Nobel Catalog data modeled. A maxillary left central incisor restoration (10 mm in height and a minimum thickness of 1.5 mm) with a full ceramic CAD/CAM material (IPS Empress CAD, Ivoclar Vivadent, Schaan, Liechtenstein) was modeled over the zirconium abutment in accordance with the two different abutment angles and central tooth anatomy. As previously stated, a dual-cure resin cement with a layer thickness of 30 µm was created (24). Elastic modulus and poisson ratios of the components, which were based on either manufacturer data or previous research (25–28) are given in Table 1 . Table 1 Elastic modulus and poisson ratios of the companents of this study Material Elastic Modulus [MPa] Poisson Ratio [v] Cortical Bone 13700 0.3 Trabecular Bone 1370 0.3 Titanium 110000 0.35 Zirconium 210000 0.3 Cement 10760 0.35 IPS Empress CAD 66500 0.19 Modelling of clinical scenarios Two different bone models of completely healed bone and fresh extraction socket were designed. While inserting the 3D model of the implant into the bone structure, three distinct clinical scenarios were taken into account. In the first scenario, the bone-implant interface was taken to be flawless and there was delayed loading after full osseointegration in the healed bone. Immediate loading of implant in the healed bone, which was the second clinical scenario, was simulated as nonosseointegrated, and the coefficient of friction between bone-implant interfaces was set to 0.3 (29). In the third clinical scenario, the upper central tooth was just extracted and the implant was inserted into the extraction socket from the palatal position as soon as the upper central tooth was extracted (29). The implant system in the healed bone model was placed in accordance with the bone curvature and at an angle of 10 degrees sagittal. The implant system in the extraction socket model was also placed in accordance with the bone curvature, at an angle of 10 degrees in the sagittal, and 3 mm deep from the bone crest. In the buccal area, 2 mm gap was left between the implant and buccal bone. The modelling process was completed by giving 2 different abutment angles (5 and 10 degrees) to the system for all the models. In all clinical scenarios, the fit of abutment to the implant was perfect. A total of 6 models were generated according to the combination of osseous models and abutment types as follows: Healed bone and late loading with 5 degree abutment profile, Healed bone and late loading with 10 degree abutment profile, Healed bone and immediate loading with 5 degree abutment profile, Healed bone and immediate loading with 10 degree abutment profile, Immediate implant in the extraction socket and immediate loading with 5 degree abutment profile, Immediate implant in the extraction socket and immediate loading with 10 degree abutment profile. Obtaining mathematical models Mathematical models are formed by dividing geometric models into simple and small pieces called meshes. After the modeling process was completed in the ANSYS Spaceclaim software, the models were mathematically created with the ANSYS Workbench software and made ready for analysis. Models prepared in ANSYS Workbench software were transferred to the LS-DYNA solver to perform the analysis. Loading of the models In all models, For oblique loading; A total force of 178 N was applied at an angle of 30 degrees from the palatal surface to the labial. For horizontal loading; A horizontal force of 25.5 N was applied in the vertical direction from the palatal surface to the labial (15, 30). The models were fixed by restricting all degrees of freedom from the nodal points located in the superior and posterior region of the maxillary cortical and trabecular bone. Stress singularity is prevented by distributing the load definitions to the nodal points in the application regions. Under the specified force and boundary conditions, a total of 12 analyzes were carried out, including 4 nonlinear and 8 liner static analyzes consisting of 3 models, 2 different abutment angles (5 and 10 degrees) and 2 forces (horizontal and oblique). Quantitative Model Information The information for the 12 analysis models created is presented in Table 2 . Table 2 The number of nodes and the number of elements Models Total # of Nodes Total # of Elements Tooth Extraction Socket – 5 degrees 211604 841306 Tooth Extraction Socket– 10 degrees 221910 884344 Healed Bone – 5 degrees 195810 776374 Healed Bone – 10 degrees 201372 798914 Combining the systems To perform analyzes in the created mathematical models and to obtain correct results, the surface relations among the parts should be defined in the analysis program. For this purpose, it was assumed that in all models, parts distribute the load in accordance with their intrinsic properties and work together. BONDED type contact definition was made between the contacting components in all analyzes. This approach was assumed that parts move with full correlation during their movement. In order to simulate the loading condition at the bone-implant interface in the immediate models, a surface-to-surface separation non-linear friction contact with a coefficient of µ = 0.3 was defined. In the immediate model, BONDED type contact definition has been defined among all other contacting parts except implant - bone. Stress Evaluation An assessment of the stress distribution surrounding implants was made using the Von Mises stress analysis. Under horizontal and oblique loading, the stress on the cortical and cancellous bone tissues was ascertained using maximum and minimum principal stress analysis. Results Table 3 shows the maximum principle stress (P1 major;tensile) and minimum principle stress (P3 minor; compression) values in cortical bone. Table 4 represents the maximum principle stress (P1 major;tensile) and minimum principle stress (P3 minor; compression) values in trabecular bone in different clinical scenarios. The highest P1 major values in cortical bone were observed when oblique forces applied in case of immediate loading to healed bone. The highest P3 minor values were observed in the same clinical scenario when horizontal force was applied. In the clinical scenario where immediate implant was applied, there is little or no stress in the cortical bone due to the transfer of stresses from the trabecular bone (Table 3 ). Table 3 Maximum principle stress and minimum principle stress values in cortical bone when oblique and horizontal forces are applied in three different clinical scenarios Clinical Scenario Functional Force (Newton) Abutment Angle (degree) P1 Major (MPa) P3 Minor (MPa) Healed Bone Late Loading 178 (Oblique) 5 30.664 57.153 10 30.854 57.237 25.5 (Horizontal) 5 20.168 20.278 10 20.484 20.242 Healed Bone Immediate Loading 178 (Oblique) 5 38.671 69.132 10 38.938 69.36 25.5 (Horizontal) 5 18.150 89.797 10 18.816 90.679 Immediate Implant Immediate Loading 178 (Oblique) 5 4.279 1.804 10 4.322 1.908 25.5 (Horizontal) 5 1.787 0.483 10 1.815 0.564 Table 4 Maximum principle stress and minimum principle stress values in trabecular bone when oblique and horizontal forces are applied in three different clinical scenarios Clinical Scenario Functional Force (Newton) Abutment Angle (degree) P1 Major P3 Minor Healed Bone Late Loading 178 (Oblique) 5 3.154 3.485 10 3.169 3.488 25.5 (Horizontal) 5 1.317 0.803 10 1.319 0.804 Healed Bone Immediate Loading 178 (Oblique) 5 6.651 12.853 10 6.718 12.893 25.5 (Horizontal) 5 5.105 12.510 10 5.155 12.633 Immediate Implant Immediate Loading 178 (Oblique) 5 11.197 29.496 10 12.880 31.921 25.5 (Horizontal) 5 6.367 16.826 10 6.808 17.944 The highest stress values in trabecular bone were observed in the clinical scenario where immediate implant was inserted to the extraction socket. This was followed by immediate loading to the healed bone and late loading to the healed bone, respectively. (Table 4 ). In all cases, the stress values increased slightly when the abutment angle was increased. The stress distributions of cortical and trabecular bones of the models were demonstrated in Fig. 1–4. The stress distribution on both types of the bone were similar when both degrees of abutment used. In both forces, the geometry of the stress distribution is different when the clinical scenario changes. The accumulation locations of stresses are different in the three clinical scenarios. In delayed loading of the healed bone, stresses accumulate in the palatal region. In the second clinical scenario of immediate loading of healed bone, stresses concentrated and accumulated around the implant, including the buccal, mesial and distal areas especially in the cortical bone. The least stress distribution in cortical bone is observed in the immediate implant application into the extraction socket due to lack of contact with cortical bone. Figure 5 demonstrates von Misses stress distributions on the implants in different scenarios and forces. Oblique forces generated higher stress values on the implants and close to its neck than horizontal forces. While immediate implant in the extraction socket has a more widespread stress accumulation geometry throughout the implant, this is followed by immediate loading and late loading to the healed bone, respectively. Discussion The stress distributions of anterior single implants placed in three different clinical scenarios including immediate implant and immediate loading, late implant and immediate loading, and late implant and late loading, were different around bone, implant and abutment. Therefore, the first null hypothesis was accepted. Previous studies (15, 17) have reported that different materials do not affect the stress distribution around the implant and bone and show similar stress distribution patterns. For this reason, prosthesis and implant materials were standardized in this study and a single material, which is frequently preferred in the anterior region, for each component was used. Instead, the 3 most common clinical situations/scenarios were simulated. When the abutment angle increased from 5 degrees to 10 degrees, there was an increase in the stress values in the bone, implant and abutment in all cases. Therefore, the second null hypothesis of this study was rejected. Consistent with our results, Uppalapati et al. (31) reported that the greater the angulation of the abutment, the greater the stress accumulation. However, in all clinical scenarios, the geometries of the stress distributions were similar in 5- and 10- degree abutments within the scenario itself. Therefore, when the abutment geometry changes, the place where the stress occurs does not change, but the stress value increases in direct proportion to the angle. Based on the results of this study, it can be recommended not to increase the profile angle too much in the abutment design. A prior investigation indicated that if the von Mises stress value in a titanium implant exceeds its yield strength of 550 MPa, it could lead to a potential failure (32). In the current study, none of the modelled implants and abutments exhibited a von Mises stress value exceeding 550 MPa. Furthermore, the principle stress values of all models in this study remained lower than the ultimate compressive (ranging from 167 to 205 MPa) and tensile (ranging from 100 to 205 MPa) strength thresholds of cortical bone. These stress values also fell within the range of ultimate strength values (ranging from 1 to 20 MPa) typically seen in trabecular bone (21). Achieving the right level of loading and ensuring proper occlusal relationships are crucial to maintain the well-being and long-term viability of the surrounding bone structure of implants (33). A force of 25.5 Newtons was exerted perpendicular to the longitudinal axis of the implant to simulate protrusive movements in this study. Additionally, a force of 178 Newtons was applied at a 30-degree oblique angle to the longitudinal axis of the implant, replicating natural clinical circumstances in the anterior zone (17, 21). Consequently, in the present study, oblique forces created more stress in all models in agreement with the previous studies (15, 24, 34). Within the three clinical scenarios examined, the greatest accumulation of stress was noted when immediate loading was applied to the immediate implant. Analysis of stress distribution geometry revealed significantly higher values in comparison to the other scenarios, particularly within the trabecular bone, while being almost absent in the cortical bone. The observed pattern aligns with interpretations found in dental literature, emphasizing that such outcomes are indicative of high primary stability, particularly when employing Titanium implants with a low elastic modulus (17). The success of immediate loading on an immediate implant depends on factors such as primary stability. On the other hand, bone quality and careful treatment planning are other factors that should be taken into consideration in clinical success. The loading protocol for dental implants, whether immediate or delayed, can significantly influence the healing process and outcomes. The choice between immediate loading and late loading of dental implants, as well as immediate loading of an immediate implant, involves a careful assessment of various clinical factors. Balancing the advantages of early restoration with the need for sufficient osseointegration is crucial to achieve successful outcomes in implant dentistry (35, 36). FEA has the potential to produce precise data for any type of mathematical or clinical issue. (37). However, the present study has some typical limitations as other research employed FEA. The restricted study designs, material characteristics, occlusal stresses, and individual variances are some of these limitations. (16, 17). Additionally, FEA provides a mathematical approximation of the issue at hand, yet it does not consider the continuous influence of biological processes (38). Only three scenarios, one material and two-piece implant designs are the focus of this investigation. The results may not be applicable to other systems applicable for the anterior region such as one-piece implants. Therefore, further investigation is warranted to validate these findings across diverse systems and assess variations following simulated clinical function. Conclusions Within the constraints of this investigation, the subsequent conclusions are possible: The clinical scenario is of great importance in the stress distribution within the bone of single implants inserted in the anterior zone. The order of clinical scenarios within the bone as well as around the implant, from best to worst, is healed bone delayed loading, healed bone immediate loading and immediately placed implant into the fresh extraction socket respectively. The distribution of stress in the bone and surrounding the implant may be influenced by the abutment angle. The stress distribution may rise with an increase in the abutment angle. Declarations Author Contribution Dear Editor,We would like to submit our manuscript titled "Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis". We strongly believe that this publication will contribute a lot to BMC Oral Health scientifically. Therefore, we would be appreciated if you could peer-review our manuscript. This article is not currently under consideration or has not been previously published in any other journal. Thank you for your attention.Sicerely yours.Elif Ozturk Bayazit, corresponding author. Funding Not applicable. Data Availability Not applicable. Competing interests Not applicable. References Thoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE. A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years. Clin Oral Implants Res. 2017;28(11):1421-32. Amorfini L, Pesce P, Migliorati M, Drago S, Storelli S, Romeo E, Menini M. Implant rehabilitation of the esthetic area: A five-year retrospective study comparing conventional and fully guided surgery. Clin Implant Dent Relat Res. 2023;25(3):438-46. 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Cite Share Download PDF Status: Published Journal Publication published 01 May, 2026 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 30 Sep, 2024 Reviews received at journal 21 Sep, 2024 Reviews received at journal 14 Sep, 2024 Reviews received at journal 11 Sep, 2024 Reviewers agreed at journal 11 Sep, 2024 Reviewers agreed at journal 06 Sep, 2024 Reviewers agreed at journal 02 Sep, 2024 Reviewers agreed at journal 01 Sep, 2024 Reviews received at journal 26 Aug, 2024 Reviewers agreed at journal 23 Aug, 2024 Reviewers invited by journal 26 Jun, 2024 Editor invited by journal 19 Jun, 2024 Editor assigned by journal 13 Jun, 2024 Submission checks completed at journal 13 Jun, 2024 First submitted to journal 07 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4544285","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319312273,"identity":"fbcb8a54-d8dd-47ab-a587-253e025ceb4c","order_by":0,"name":"Elif Ozturk Bayazit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIie3QvQrCMBDA8RPBqZpNUhz6CicFcSj4KufS2dFRcBZXxUdwEQrOB4FsxbXiYPsAQseOJi5uNm6C+W8H9yMfAD7fL8bQYUoAhB1o4UK0UZQChCtL0JWAIch2ciGD+5q5pGQWX47zukSIxJA/k1D3iInS7qR4ZNJcbLw/0GeCOkCeN6o3KfKTJYS3ViJqc4oK4l2eNY4kAEskis3Z7ZRQp2jfgrLon6eEsv0tA6WqqjE/JrZ5dm2WSSRGLeSdfG1K13Wb4G+2fT6f7596AiN4SYGFd23FAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Elif","middleName":"Ozturk","lastName":"Bayazit","suffix":""},{"id":319312277,"identity":"660dec2d-6680-4f17-aee0-740c39f01a76","order_by":1,"name":"Nadine von Krockow","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Nadine","middleName":"","lastName":"von Krockow","suffix":""},{"id":319312278,"identity":"054b2c97-5424-4b54-a60b-3ff6cb8def0f","order_by":2,"name":"Ricardo Curcio","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ricardo","middleName":"","lastName":"Curcio","suffix":""}],"badges":[],"createdAt":"2024-06-07 07:21:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4544285/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4544285/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-026-08405-4","type":"published","date":"2026-05-01T15:58:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59264816,"identity":"b9865df6-e183-47c9-97fa-27cc94304c5c","added_by":"auto","created_at":"2024-06-28 10:47:23","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3160083,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum principle stress distribution on cortical bone. For all figures: 1. Healed bone late loading, 2. Healed bone immediate loading, 3. Immediate implant immediate loading, A. 5 degree oblique force, B. 5 degree horizontal force, C. 10 degree oblique force, D. 10 degree horizontal force.\u003c/p\u003e","description":"","filename":"Fig1CorticalMaxMerged.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/a5f31dc3c08ff66b5a8b320d.jpg"},{"id":59264812,"identity":"e0330d01-7d71-4d14-a67c-a2462e67f3f5","added_by":"auto","created_at":"2024-06-28 10:47:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":920622,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum principle stress distribution on trabecular bone\u003c/p\u003e","description":"","filename":"Fig2TrabecularMaxMerged.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/e7f33d50290b7936d3aa96d0.jpg"},{"id":59265284,"identity":"f122c5bd-428e-4a98-83db-611bb390b1eb","added_by":"auto","created_at":"2024-06-28 10:55:22","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":922161,"visible":true,"origin":"","legend":"\u003cp\u003eMinimum principle stress distribution on cortical bone\u003c/p\u003e","description":"","filename":"Fig3CorticalMinMerged.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/46b153090625334b74763646.jpg"},{"id":59264813,"identity":"52ae6f8f-6ebf-4423-822e-65a2b8a3de34","added_by":"auto","created_at":"2024-06-28 10:47:22","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":986746,"visible":true,"origin":"","legend":"\u003cp\u003eMinimum principle stress distribution on trabecular bone\u003c/p\u003e","description":"","filename":"Fig4TrabecularMinMerged.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/32d6730d01aeb0a76cda51c5.jpg"},{"id":59264815,"identity":"224f678d-b94e-4106-916f-11d43cd2419d","added_by":"auto","created_at":"2024-06-28 10:47:22","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1558592,"visible":true,"origin":"","legend":"\u003cp\u003evon Mises stresses on implants\u003c/p\u003e","description":"","filename":"Fig5ImplantsMerged.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/0711499412f4219272283db9.jpg"},{"id":108437909,"identity":"9f34acd9-3660-42c8-ad5e-53a5f7f9b714","added_by":"auto","created_at":"2026-05-04 16:04:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7813684,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4544285/v1/3e4d3028-46d5-484b-bbae-2be0c6a57567.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRebuilding a single lost tooth with precision is a major challenge in reconstructive dentistry, especially in the aesthetic area. When restoring a single lost tooth, there are several restorative options available. Implant-supported crowns are frequently used in the esthetic zone, especially with the development of tooth-colored materials with modern implantology (2).\u003c/p\u003e \u003cp\u003eA number of variables, such as implant design, prosthesis material and design, and host features such recipient bone quality, may impact the long-term clinical outcome of implant-supported restorations (3, 4). A good and effective treatment plan requires the clinician to carefully analyze each of these factors (2).\u003c/p\u003e \u003cp\u003eAlveolar resorption starts after extraction and can continue for longer than a year (5). Because of its low thickness and decreased blood supply from the periodontal tissues, the buccal bone plate in the maxilla resorbs more quickly than the palatal bone (5\u0026ndash;7). In order to facilitate later implant placement in the healed bone, it has been proposed that immediate implant implantation in the extraction socket to decrease bone resorption (8).\u003c/p\u003e \u003cp\u003eImmediate loading protocols within physiological limits especially on the esthetic zone is reported to be crucial in order to prevent the existing osseous and gingival architecture (9). However, clinical studies in the literature are contradictory. Moy et al. (10), reported higher success rates when implants were loaded with delay compared to that of immediately loaded. On the other hand, Henningsten et al. (11) reported comparable results between differently loaded anteriorly placed implants. Different results in clinical studies may be due to various reasons, such as differences in methodology. However, there is still a need for in vitro studies examining dental implants in different clinical scenarios to help interpret and predict clinical outcomes.\u003c/p\u003e \u003cp\u003eDental implants' internal geometry is a crucial factor effecting the clinical success as it is responsible for the bacterial infiltration via the implant-abutment interface (12). Therefore, a tight fit between the implant and the prosthetic superstructure is a desirable feature to prevent bacterial invasion. Previous research assessed internal conical connection implants with various internal angles in vitro for this reason. (13, 14). However, evaluating differently angulated abutments in vivo in different clinical scenarios is expensive, difficult, and time consuming.\u003c/p\u003e \u003cp\u003eDistribution of stress generated by chewing forces around dental implants is another factor influencing the clinical success (15). One effective technique for assessing the stresses and strains that the forces in the oral environment place on dental implants and the surrounding tissues is to employ finite element analysis (FEA) (16, 17). Moreover, FEA gives dental professionals the chance to comprehend and evaluate implant designs, materials, and their effects on the surrounding osseous structures more quickly, effectively and economically (16, 18, 19). Prior research has used FEA with different methodology to assess the stress accumulation on peripheral bone and implants positioned anteriorly. (15, 20\u0026ndash;23). Nevertheless, there is a lack of information in the literature regarding three-dimensional (3D) FEA when different abutment designs used in different clinical scenarios such as immediate or late insertion of dental implants are insufficient in the literature. Therefore, the aim of this study was to evaluate the stress distributions of anteriorly placed single implants in different clinical scenarios including extraction socket or healed bone as well as immediate or late loading. The null hypotheses were tested that, 1. The stress distributions of anterior single implants placed in three different clinical scenarios (i. immediate implant and immediate loading, ii. late implant and immediate loading, iii. late implant and late loading) will be different around bone, implant and abutment, 2. Two different abutment designs (5 and 10 degrees) will not influence the stress distribution around bone, implant and abutment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eOn HP workstations with an INTEL Xeon E-2286 processor clocked at 2.40 GHz and 64 GB ECC memory, 3D mesh structure arrangement and its conversion into a mathematically appropriate solid mesh structure, as well as the creation of 3D FEA models, were carried out.\u003c/p\u003e \u003cp\u003eObtaining the .stl model from tomography data was done in a 3D software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.slicer.org\u003c/span\u003e\u003cspan address=\"http://www.slicer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) (3D Slicer image computing platform. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.slicer.org\u003c/span\u003e\u003cspan address=\"http://www.slicer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 4 July 2023). ANSYS Spaceclaim software was used for reverse engineering and three-dimensional computer-aided design (CAD); ANSYS Workbench software (Ansys Inc., Canonsburg, PA, USA) was used for solid model adaptation to the analysis environment and for creating optimized meshes; the finite element models were solved using the LS-DYNA (LSTC, Livermore, CA, USA) solver.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eModelling of Cortical and Trabecular Bone Structures\u003c/h2\u003e \u003cp\u003eThe study's cortical and trabecular bone model was created using CT scan data from an adult patient who was edentulous. Reconstructed tomography data has a 0.1 mm slice thickness. The tomography data was imported in the DICOM (.dcm) format into the 3D Slicer program. Using 3DSlicer software, CT data in the DICOM format was segmented into a three-dimensional model by setting the proper Hounsfield values. A.stl file was used for model export.\u003c/p\u003e \u003cp\u003eBy adding a 2 mm inner offset to the maxillary bone, a 2 mm thick cortical bone model was produced.\u003c/p\u003e \u003cp\u003eBy reference to the inside surface of the three-dimensional maxillary cortical bone, trabecular bone was identified.\u003c/p\u003e \u003cp\u003eThe modeling procedure was finished once all of the ready models were positioned in the proper 3D coordinates using the modeller ANSYS Spaceclaim program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eModelling of Implant, Abutment, Screw, Cement and Prosthesis\u003c/h2\u003e \u003cp\u003eA titanium bone level implant (\u0026Oslash;: 3.75 mm, 10 mm in height), a zirconium abutment, and a screw were designed and modeled after their respective commercial counterparts (Nobel Paralell Conical Connection) with the same 3D design software. Following that, a prefabricated zirconium abutment was designed over the implant (\u0026Oslash;: 4.35 mm,height: 7 mm, gingival height (GH): 3 mm, finishing line thickness: 0.5 mm). Esthetic abutments with two different emergence profiles of 5 degrees and 10 degrees were designed according to the Nobel Catalog data modeled. A maxillary left central incisor restoration (10 mm in height and a minimum thickness of 1.5 mm) with a full ceramic CAD/CAM material (IPS Empress CAD, Ivoclar Vivadent, Schaan, Liechtenstein) was modeled over the zirconium abutment in accordance with the two different abutment angles and central tooth anatomy. As previously stated, a dual-cure resin cement with a layer thickness of 30 \u0026micro;m was created (24).\u003c/p\u003e \u003cp\u003eElastic modulus and poisson ratios of the components, which were based on either manufacturer data or previous research (25\u0026ndash;28) are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eElastic modulus and poisson ratios of the companents of this study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElastic Modulus [MPa]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoisson Ratio [v]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCortical Bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrabecular Bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitanium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZirconium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPS Empress CAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eModelling of clinical scenarios\u003c/h2\u003e \u003cp\u003eTwo different bone models of completely healed bone and fresh extraction socket were designed. While inserting the 3D model of the implant into the bone structure, three distinct clinical scenarios were taken into account. In the first scenario, the bone-implant interface was taken to be flawless and there was delayed loading after full osseointegration in the healed bone. Immediate loading of implant in the healed bone, which was the second clinical scenario, was simulated as nonosseointegrated, and the coefficient of friction between bone-implant interfaces was set to 0.3 (29). In the third clinical scenario, the upper central tooth was just extracted and the implant was inserted into the extraction socket from the palatal position as soon as the upper central tooth was extracted (29).\u003c/p\u003e \u003cp\u003eThe implant system in the healed bone model was placed in accordance with the bone curvature and at an angle of 10 degrees sagittal.\u003c/p\u003e \u003cp\u003eThe implant system in the extraction socket model was also placed in accordance with the bone curvature, at an angle of 10 degrees in the sagittal, and 3 mm deep from the bone crest. In the buccal area, 2 mm gap was left between the implant and buccal bone.\u003c/p\u003e \u003cp\u003eThe modelling process was completed by giving 2 different abutment angles (5 and 10 degrees) to the system for all the models. In all clinical scenarios, the fit of abutment to the implant was perfect.\u003c/p\u003e \u003cp\u003eA total of 6 models were generated according to the combination of osseous models and abutment types as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealed bone and late loading with 5 degree abutment profile,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealed bone and late loading with 10 degree abutment profile,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealed bone and immediate loading with 5 degree abutment profile,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealed bone and immediate loading with 10 degree abutment profile,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eImmediate implant in the extraction socket and immediate loading with 5 degree abutment profile,\u003c/p\u003e\u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eImmediate implant in the extraction socket and immediate loading with 10 degree abutment profile.\u003c/p\u003e\u003c/li\u003e\u003c/ol\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eObtaining mathematical models\u003c/h2\u003e \u003cp\u003eMathematical models are formed by dividing geometric models into simple and small pieces called meshes. After the modeling process was completed in the ANSYS Spaceclaim software, the models were mathematically created with the ANSYS Workbench software and made ready for analysis. Models prepared in ANSYS Workbench software were transferred to the LS-DYNA solver to perform the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eLoading of the models\u003c/h2\u003e \u003cp\u003eIn all models,\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFor oblique loading; A total force of 178 N was applied at an angle of 30 degrees from the palatal surface to the labial.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFor horizontal loading; A horizontal force of 25.5 N was applied in the vertical direction from the palatal surface to the labial (15, 30).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe models were fixed by restricting all degrees of freedom from the nodal points located in the superior and posterior region of the maxillary cortical and trabecular bone.\u003c/p\u003e \u003cp\u003eStress singularity is prevented by distributing the load definitions to the nodal points in the application regions.\u003c/p\u003e \u003cp\u003eUnder the specified force and boundary conditions, a total of 12 analyzes were carried out, including 4 nonlinear and 8 liner static analyzes consisting of 3 models, 2 different abutment angles (5 and 10 degrees) and 2 forces (horizontal and oblique).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Model Information\u003c/h2\u003e \u003cp\u003eThe information for the 12 analysis models created is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number of nodes and the number of elements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModels\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal # of Nodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal # of Elements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTooth Extraction Socket \u0026ndash; 5 degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e211604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e841306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTooth Extraction Socket\u0026ndash; 10 degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e221910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e884344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealed Bone \u0026ndash; 5 degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e195810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e776374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealed Bone \u0026ndash; 10 degrees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e798914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCombining the systems\u003c/h2\u003e \u003cp\u003eTo perform analyzes in the created mathematical models and to obtain correct results, the surface relations among the parts should be defined in the analysis program. For this purpose, it was assumed that in all models, parts distribute the load in accordance with their intrinsic properties and work together.\u003c/p\u003e \u003cp\u003eBONDED type contact definition was made between the contacting components in all analyzes. This approach was assumed that parts move with full correlation during their movement.\u003c/p\u003e \u003cp\u003eIn order to simulate the loading condition at the bone-implant interface in the immediate models, a surface-to-surface separation non-linear friction contact with a coefficient of \u0026micro;\u0026thinsp;=\u0026thinsp;0.3 was defined.\u003c/p\u003e \u003cp\u003eIn the immediate model, BONDED type contact definition has been defined among all other contacting parts except implant - bone.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eStress Evaluation\u003c/h2\u003e \u003cp\u003eAn assessment of the stress distribution surrounding implants was made using the Von Mises stress analysis. Under horizontal and oblique loading, the stress on the cortical and cancellous bone tissues was ascertained using maximum and minimum principal stress analysis.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the maximum principle stress (P1 major;tensile) and minimum principle stress (P3 minor; compression) values in cortical bone. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e represents the maximum principle stress (P1 major;tensile) and minimum principle stress (P3 minor; compression) values in trabecular bone in different clinical scenarios. The highest P1 major values in cortical bone were observed when oblique forces applied in case of immediate loading to healed bone. The highest P3 minor values were observed in the same clinical scenario when horizontal force was applied. In the clinical scenario where immediate implant was applied, there is little or no stress in the cortical bone due to the transfer of stresses from the trabecular bone (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaximum principle stress and minimum principle stress values in cortical bone when oblique and horizontal forces are applied in three different clinical scenarios\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Scenario\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunctional Force (Newton)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbutment Angle (degree)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP1 Major (MPa)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP3 Minor\u003c/p\u003e \u003cp\u003e(MPa)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealed Bone Late Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealed Bone Immediate Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eImmediate Implant Immediate Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaximum principle stress and minimum principle stress values in trabecular bone when oblique and horizontal forces are applied in three different clinical scenarios\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Scenario\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunctional Force (Newton)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbutment Angle (degree)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP1 Major\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP3 Minor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealed Bone Late Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealed Bone Immediate Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eImmediate Implant Immediate Loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e178 (Oblique)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.5 (Horizontal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe highest stress values in trabecular bone were observed in the clinical scenario where immediate implant was inserted to the extraction socket. This was followed by immediate loading to the healed bone and late loading to the healed bone, respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn all cases, the stress values increased slightly when the abutment angle was increased.\u003c/p\u003e \u003cp\u003eThe stress distributions of cortical and trabecular bones of the models were demonstrated in Fig.\u0026nbsp;1\u0026ndash;4. The stress distribution on both types of the bone were similar when both degrees of abutment used. In both forces, the geometry of the stress distribution is different when the clinical scenario changes. The accumulation locations of stresses are different in the three clinical scenarios. In delayed loading of the healed bone, stresses accumulate in the palatal region. In the second clinical scenario of immediate loading of healed bone, stresses concentrated and accumulated around the implant, including the buccal, mesial and distal areas especially in the cortical bone. The least stress distribution in cortical bone is observed in the immediate implant application into the extraction socket due to lack of contact with cortical bone.\u003c/p\u003e \u003cp\u003eFigure 5 demonstrates von Misses stress distributions on the implants in different scenarios and forces. Oblique forces generated higher stress values on the implants and close to its neck than horizontal forces. While immediate implant in the extraction socket has a more widespread stress accumulation geometry throughout the implant, this is followed by immediate loading and late loading to the healed bone, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe stress distributions of anterior single implants placed in three different clinical scenarios including immediate implant and immediate loading, late implant and immediate loading, and late implant and late loading, were different around bone, implant and abutment. Therefore, the first null hypothesis was accepted. Previous studies (15, 17) have reported that different materials do not affect the stress distribution around the implant and bone and show similar stress distribution patterns. For this reason, prosthesis and implant materials were standardized in this study and a single material, which is frequently preferred in the anterior region, for each component was used. Instead, the 3 most common clinical situations/scenarios were simulated.\u003c/p\u003e \u003cp\u003eWhen the abutment angle increased from 5 degrees to 10 degrees, there was an increase in the stress values in the bone, implant and abutment in all cases. Therefore, the second null hypothesis of this study was rejected. Consistent with our results, Uppalapati et al. (31) reported that the greater the angulation of the abutment, the greater the stress accumulation. However, in all clinical scenarios, the geometries of the stress distributions were similar in 5- and 10- degree abutments within the scenario itself. Therefore, when the abutment geometry changes, the place where the stress occurs does not change, but the stress value increases in direct proportion to the angle. Based on the results of this study, it can be recommended not to increase the profile angle too much in the abutment design.\u003c/p\u003e \u003cp\u003eA prior investigation indicated that if the von Mises stress value in a titanium implant exceeds its yield strength of 550 MPa, it could lead to a potential failure (32). In the current study, none of the modelled implants and abutments exhibited a von Mises stress value exceeding 550 MPa. Furthermore, the principle stress values of all models in this study remained lower than the ultimate compressive (ranging from 167 to 205 MPa) and tensile (ranging from 100 to 205 MPa) strength thresholds of cortical bone. These stress values also fell within the range of ultimate strength values (ranging from 1 to 20 MPa) typically seen in trabecular bone (21).\u003c/p\u003e \u003cp\u003eAchieving the right level of loading and ensuring proper occlusal relationships are crucial to maintain the well-being and long-term viability of the surrounding bone structure of implants (33). A force of 25.5 Newtons was exerted perpendicular to the longitudinal axis of the implant to simulate protrusive movements in this study. Additionally, a force of 178 Newtons was applied at a 30-degree oblique angle to the longitudinal axis of the implant, replicating natural clinical circumstances in the anterior zone (17, 21). Consequently, in the present study, oblique forces created more stress in all models in agreement with the previous studies (15, 24, 34).\u003c/p\u003e \u003cp\u003eWithin the three clinical scenarios examined, the greatest accumulation of stress was noted when immediate loading was applied to the immediate implant. Analysis of stress distribution geometry revealed significantly higher values in comparison to the other scenarios, particularly within the trabecular bone, while being almost absent in the cortical bone. The observed pattern aligns with interpretations found in dental literature, emphasizing that such outcomes are indicative of high primary stability, particularly when employing Titanium implants with a low elastic modulus (17). The success of immediate loading on an immediate implant depends on factors such as primary stability. On the other hand, bone quality and careful treatment planning are other factors that should be taken into consideration in clinical success.\u003c/p\u003e \u003cp\u003eThe loading protocol for dental implants, whether immediate or delayed, can significantly influence the healing process and outcomes. The choice between immediate loading and late loading of dental implants, as well as immediate loading of an immediate implant, involves a careful assessment of various clinical factors. Balancing the advantages of early restoration with the need for sufficient osseointegration is crucial to achieve successful outcomes in implant dentistry (35, 36).\u003c/p\u003e \u003cp\u003eFEA has the potential to produce precise data for any type of mathematical or clinical issue. (37). However, the present study has some typical limitations as other research employed FEA. The restricted study designs, material characteristics, occlusal stresses, and individual variances are some of these limitations. (16, 17). Additionally, FEA provides a mathematical approximation of the issue at hand, yet it does not consider the continuous influence of biological processes (38). Only three scenarios, one material and two-piece implant designs are the focus of this investigation. The results may not be applicable to other systems applicable for the anterior region such as one-piece implants. Therefore, further investigation is warranted to validate these findings across diverse systems and assess variations following simulated clinical function.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWithin the constraints of this investigation, the subsequent conclusions are possible:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe clinical scenario is of great importance in the stress distribution within the bone of single implants inserted in the anterior zone.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe order of clinical scenarios within the bone as well as around the implant, from best to worst, is healed bone delayed loading, healed bone immediate loading and immediately placed implant into the fresh extraction socket respectively.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe distribution of stress in the bone and surrounding the implant may be influenced by the abutment angle. The stress distribution may rise with an increase in the abutment angle.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDear Editor,We would like to submit our manuscript titled \"Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis\". We strongly believe that this publication will contribute a lot to BMC Oral Health scientifically. Therefore, we would be appreciated if you could peer-review our manuscript. This article is not currently under consideration or has not been previously published in any other journal. Thank you for your attention.Sicerely yours.Elif Ozturk Bayazit, corresponding author.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE. A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years. Clin Oral Implants Res. 2017;28(11):1421-32.\u003c/li\u003e\n\u003cli\u003eAmorfini L, Pesce P, Migliorati M, Drago S, Storelli S, Romeo E, Menini M. 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Evaluation of Stress Generated with Different Abutment Materials and Angulations under Axial and Oblique Loading in the Anterior Maxilla: Three-Dimensional Finite Element Analysis. Int J Dent. 2021;2021:9205930.\u003c/li\u003e\n\u003cli\u003eTsumanuma KTS, Caldas RA, Silva ID, Miranda ME, Brandt WC, Vitti RP. Finite Element Analysis of Stress in Anterior Prosthetic Rehabilitation with Zirconia Implants with and without Cantilever. Eur J Dent. 2021;15(4):669-74.\u003c/li\u003e\n\u003cli\u003eKaleli N, Sarac D, Kulunk S, Ozturk O. Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional finite element analysis study. J Prosthet Dent. 2018;119(3):437-45.\u003c/li\u003e\n\u003cli\u003eCaglar A, Bal BT, Karakoca S, Aydin C, Yilmaz H, Sarisoy S. Three-dimensional finite element analysis of titanium and yttrium-stabilized zirconium dioxide abutments and implants. Int J Oral Maxillofac Implants. 2011;26(5):961-9.\u003c/li\u003e\n\u003cli\u003eSevimay M, Turhan F, Kilicarslan MA, Eskitascioglu G. Three-dimensional finite element analysis of the effect of different bone quality on stress distribution in an implant-supported crown. J Prosthet Dent. 2005;93(3):227-34.\u003c/li\u003e\n\u003cli\u003eKeilig L, Stark H, Bourauel C. Does the Material Stiffness of Novel High-Performance Polymers for Fixed Partial Dentures Influence Their Biomechanical Behavior? Int J Prosthodont. 2016;30(6):595-7.\u003c/li\u003e\n\u003cli\u003eBergamo ETP, Yamaguchi S, Coelho PG, Lopes ACO, Lee C, Bonfante G, et al. Survival of implant-supported resin-matrix ceramic crowns: In silico and fatigue analyses. Dent Mater. 2021;37(3):523-33.\u003c/li\u003e\n\u003cli\u003eLiu R, Yang Z, Tan J, Chen L, Liu H, Yang J. Immediate implant placement for a single anterior maxillary tooth with a facial bone wall defect: A prospective clinical study with a one-year follow-up period. Clin Implant Dent Relat Res. 2019;21(6):1164-74.\u003c/li\u003e\n\u003cli\u003eGungor MB, Nemli SK, Bal BT, Unver S, Dogan A. Effect of surface treatments on shear bond strength of resin composite bonded to CAD/CAM resin-ceramic hybrid materials. J Adv Prosthodont. 2016;8(4):259-66.\u003c/li\u003e\n\u003cli\u003eUppalapati V, Kumar S, Aggarwal R, Bhat I, Munaganti J, Khan S. Three-dimensional Finite Element Stress Pattern Analysis in Bone around Implant-supported Abutment with Different Angulations under Axial and Oblique Load. J Contemp Dent Pract. 2023;24(1):16-20.\u003c/li\u003e\n\u003cli\u003eAkca K, Iplikcioglu H. Finite element stress analysis of the effect of short implant usage in place of cantilever extensions in mandibular posterior edentulism. J Oral Rehabil. 2002;29(4):350-6.\u003c/li\u003e\n\u003cli\u003eOzturk O, Kulunk T, Kulunk S. Influence of different implant-abutment connections on stress distribution in single tilted implants and peripheral bone: A three-dimensional finite element analysis. Biomed Mater Eng. 2018;29(4):513-26.\u003c/li\u003e\n\u003cli\u003eLiu T, Mu Z, Yu T, Wang C, Huang Y. Biomechanical comparison of implant inclinations and load times with the all-on-4 treatment concept: a three-dimensional finite element analysis. Comput Methods Biomech Biomed Engin. 2019;22(6):585-94.\u003c/li\u003e\n\u003cli\u003eZhou W, Gallucci GO, Chen S, Buser D, Hamilton A. Placement and Loading Protocols for Single Implants in Different Locations: A Systematic Review. Int J Oral Maxillofac Implants. 2021;36(4):e72-e89.\u003c/li\u003e\n\u003cli\u003ePedrinaci I, Sun TC, Sanz-Alonso M, Sanz-Esporrin J, Hamilton A, Gallucci GO. Implant survival in the anterior mandible: A retrospective cohort study. Clin Oral Implants Res. 2023;34(5):463-74.\u003c/li\u003e\n\u003cli\u003eBrunski JB, Puleo DA, Nanci A. Biomaterials and biomechanics of oral and maxillofacial implants: current status and future developments. Int J Oral Maxillofac Implants. 2000;15(1):15-46.\u003c/li\u003e\n\u003cli\u003eAslam A, Hassan SH, Aslam HM, Khan DA. Effect of platform switching on peri-implant bone: A 3D finite element analysis. J Prosthet Dent. 2019;121(6):935-40.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4544285/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4544285/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e \u003cp\u003eTo evaluate the stress distributions of anteriorly placed dental implants in different clinical scenarios including extraction socket or healed bone as well as immediate or late loading.\u003c/p\u003e \u003cp\u003eMaterial and Methods\u003c/p\u003e \u003cp\u003eStandard tessellation language (STL) files of original components were used for the in-silico modelling of implant and abutments. The implant was placed into the bone block to imitate three different clinical scenarios including: i. healed bone-delayed loading, ii. healed bone-immediate loading, iii. immediate implant-immediate loading.\u003c/p\u003e \u003cp\u003eIn all models, both a horizontal force (25.5 N) and a 30-degree oblique force (178 N) were applied to the long axis of the implant to the palatal surface of the restoration. The stress distribution was evaluated.\u003c/p\u003e \u003cp\u003eResults\u003c/p\u003e \u003cp\u003eThe highest stress values in trabecular bone were observed in the clinical scenario where immediate implant was inserted to the extraction socket followed by immediate loading to the healed bone and late loading to the healed bone, respectively.\u003c/p\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003cp\u003eThe difference in stress distribution is much more evident when the clinical scenario changes, both in values and geometric distributions of stresses, than when the abutment angle changes. Oblique forces create more stress on both the bone and around the implant.\u003c/p\u003e","manuscriptTitle":"Stress Distribution of Different Anterior Single Implants: A 3D Finite Element Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 10:47:17","doi":"10.21203/rs.3.rs-4544285/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-30T12:53:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-21T21:49:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-14T16:31:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-11T13:22:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137280094633564953036807005797216416761","date":"2024-09-11T06:21:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238206550316956569713246606173522233193","date":"2024-09-06T15:24:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314612166661015073513409364570925313626","date":"2024-09-02T10:06:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29358471653126171773733370635341832655","date":"2024-09-02T02:33:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-26T09:27:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91772368541685257332382855159314479052","date":"2024-08-23T11:25:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-26T12:13:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-19T12:14:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-13T10:45:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-13T10:45:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-06-07T07:19:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1706965-ca22-45ae-b621-796b754090a3","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:03:48+00:00","versionOfRecord":{"articleIdentity":"rs-4544285","link":"https://doi.org/10.1186/s12903-026-08405-4","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2026-05-01 15:58:37","publishedOnDateReadable":"May 1st, 2026"},"versionCreatedAt":"2024-06-28 10:47:17","video":"","vorDoi":"10.1186/s12903-026-08405-4","vorDoiUrl":"https://doi.org/10.1186/s12903-026-08405-4","workflowStages":[]},"version":"v1","identity":"rs-4544285","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4544285","identity":"rs-4544285","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}