subperiosteal implants
Finite Element Analysis of Subperiosteal Implants in Edentulism-On the Basis of the MaI Implant® by Integra Implants
Full text link: https://pubmed.ncbi.nlm.nih.gov/38068210/
Finite Element Analysis of Subperiosteal Implants in Edentulism—On the Basis of the MaI Implant® by Integra Implants®
1. Scientific Reference
- Study Title: Finite Element Analysis of Subperiosteal Implants in Edentulism—On the Basis of the MaI Implant® by Integra Implants®
- Authors: Rafal Zielinski, Jerzy Sowinski, Martyna Piechaczek, Jakub Okulski, Marcin Kozakiewicz
- Scientific Journal: Materials
- Year of Publication: 2023
- DOI: 10.3390/ma16237466
2. Scientific Background
Implant-supported rehabilitation of completely edentulous patients presenting severe maxillary atrophy remains a complex clinical situation. In patients classified as Cawood and Howell V or VI, the residual bone volume is often insufficient to allow placement of conventional endosseous dental implants without prior bone augmentation procedures. Autologous grafts, particularly those harvested from the iliac crest or calvarium, remain reference solutions but involve an additional surgical site and associated morbidity.
Zygomatic implants constitute another therapeutic option, but they are associated with various potential complications reported in the literature. In this context, customized subperiosteal implants designed through the CAD/CAM digital workflow and metallic 3D printing have generated renewed interest. MaI Implants® (Maxilla/Mandible Personalized Implants) represent one of these technological developments intended to provide fixed rehabilitation for patients presenting advanced bone resorption.
3. Study Objective
The objective of this study was to evaluate the mechanical behavior of customized MaI Implants® subperiosteal implants under conditions simulating the real oral environment using finite element analysis (Finite Element Analysis, FEA).
The authors sought to determine the influence of different mechanical parameters, particularly the magnitude and orientation of applied loads, on the displacements, deformations, and stresses generated within the implant. The null hypothesis formulated by the researchers was that MaI Implants® would not be suitable for the rehabilitation of patients presenting severe maxillary atrophy.
4. Methodology
This research corresponds to a preclinical numerical modeling study using the finite element method.
Two configurations were investigated:
- an individual subperiosteal implant;
- a full arch consisting of two subperiosteal implants connected by a bar.
The simulations were performed using ANSYS Workbench 19.4 software. The implants were modeled in Ti-6Al-4V Grade 5 alloy with a yield strength of 1092 MPa.
The researchers applied loads of:
- 100 N;
- 800 N.
The loading conditions were tested at different angles (90°, 60°, and 30° according to the analyses performed). The evaluated parameters included:
- displacements;
- deformations;
- Von Mises stresses;
- the influence of anchorage points and implant stabilization.
5. Main Results
Increasing the applied load resulted in a systematic increase in displacements across all studied models. When the load increased from 100 N to 800 N, displacements increased substantially in the various implant components.
The orientation of the load proved to be particularly critical. When the loading angle changed from 90° to 30°, the mean displacement value observed at the multi-units increased by 576% for the individual implant model.
The authors also report that the stresses measured at the multi-units ranged from 23.7 MPa to 268.5 MPa depending on the simulated conditions. These values remained below the yield strength of the material used.
The study finally demonstrates that the absence of adequate stabilization constitutes the factor with the greatest impact on observed displacements, with positional changes becoming significant compared with the initial situation.
6. Clinical Analysis
This study provides useful information regarding the biomechanical behavior of customized subperiosteal implants intended for edentulous patients presenting severe bone atrophy.
One of the major findings lies in the predominant influence of oblique loading. The results suggest that non-axial forces generate substantially greater displacements than vertical loads. This observation is consistent with biomechanical principles generally accepted in implantology, according to which lateral force components are more detrimental to implant systems than forces applied along the primary loading axis.
The study also highlights the importance of primary stabilization achieved through anchorage screws. In the context of customized subperiosteal implants, stress distribution depends heavily on the design of the implant framework and its areas of osseous fixation.
From a clinical perspective, these data are particularly relevant for the digital planning of customized implants intended for patients presenting severely resorbed maxillae. They suggest that implant design and anchorage quality may be as important as the intrinsic properties of the material used.
However, it should be emphasized that the results originate from a numerical simulation and do not reflect all biological phenomena observed in vivo, particularly bone remodeling, tissue responses, or repetitive dynamic stresses associated with daily mastication.
7. Clinical Applications
The results of this study may be of interest in several areas of advanced implantology:
- implant-supported rehabilitation of completely edentulous patients;
- management of severe maxillary atrophy (Cawood and Howell V–VI);
- digital planning of customized subperiosteal implants;
- CAD/CAM design of customized maxillofacial implants;
- optimization of screw anchorage systems;
- development of implant surgery protocols assisted by digital technologies.
The data may also contribute to improving the mechanical design of future subperiosteal implants manufactured through metallic 3D printing.
8. Level of Evidence, Limitations, and Transparency
This study corresponds to a preclinical numerical simulation study using finite element analysis.
The level of evidence remains limited because no prospective clinical data or patient follow-up were included in the analysis. The results reflect the theoretical behavior of the device in a virtual environment rather than its actual clinical performance.
Among the identifiable limitations:
- absence of direct clinical validation;
- absence of implant survival data;
- absence of evaluation of biological complications;
- simplifications inherent to numerical models;
- standardized loading conditions that do not reproduce the full complexity of real masticatory forces.
No specific conflict of interest is mentioned in the provided excerpts. This information is not detailed in the available material.
9. Key Study Points
- Study Type: Finite Element Analysis (FEA)
- Level of Evidence: Experimental preclinical
- Population or Number of Studies Analyzed: Not applicable
- Number of Patients or Implants: Two numerical models investigated
- Follow-up Duration: Not applicable
- Primary Outcome Evaluated: Displacements, deformations, and mechanical stresses
- Material Studied: Ti-6Al-4V Grade 5
- Main Result: Oblique loads substantially increase implant displacements
- Scientific Conclusion: Anchorage stability strongly influences the mechanical behavior of the system
- Potential Limitations: Numerical modeling without clinical validation
10. Scientific Impact
This publication contributes to the literature dedicated to customized subperiosteal implants, a field undergoing rapid development due to advances in 3D imaging, digital planning, and additive manufacturing.
Unlike several previous studies that focused on simplified models or limited anatomical regions, this study analyzes a complete system designed for the rehabilitation of patients presenting severe maxillary atrophy. It therefore provides complementary data regarding the overall mechanical behavior of MaI Implants®.
The findings reinforce the concept that the performance of these devices depends not only on the material used but also on implant geometry, the quality of osseous anchorage, and the orientation of functional loads.
This study therefore constitutes a useful contribution to the future optimization of customized subperiosteal implants while emphasizing the need for clinical studies capable of confirming the observations obtained through numerical simulation.
11. Editorial Conclusion
This biomechanical analysis of MaI Implants® highlights the importance of implant stabilization and the orientation of applied forces in the mechanical behavior of customized subperiosteal implants. The results obtained through finite element analysis suggest that these devices can withstand substantial stresses while remaining within the mechanical limits of the material studied. Nevertheless, as with any numerical modeling study, these conclusions must be interpreted with caution and considered a preliminary step toward long-term clinical validation of these solutions intended for patients presenting severe bone atrophy.
