a comparative finite elemental analysis of glass abutment supported and unsupported cantilever fixed...

7/26/2019 A Comparative Finite Elemental Analysis of Glass Abutment Supported and Unsupported Cantilever Fixed Partial D

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A comparative finite elemental analysis of glass

abutment supported and unsupported cantilever

fixed partial denture

Ravikumar Ramakrishaniah a, Abdulaziz A. Al kheraifb,Mohamed A. Elsharawy b, Ayman K. Alsaleh b,Karem M. Ismail Mohamed c, Ihtesham Ur Rehman d,

a College of Applied Medical Sciences, Department of Dental Health, King Saud University, Riyadh, Saudi Arabiab College of Applied Medical Sciences, Dental Biomaterials Research Chair, Department of Dental Health,

King Saud University, Riyadh, Saudi Arabiac Advanced Manufacturing Institute, College of Engineering, King Saud University, Riyadh, Saudi Arabiad Department of Material Science and Engineering, The Kroto Research Institute, The University of Sheffield,

Sheffield S3 7HQ, UK

a r t i c l e i n f o

Article history:

Received 31 October 2013

Received in revised form

28 December 2014Accepted 7 February 2015

Keywords:

Finite element analysis

Micro-computed tomography

ZX-27 glass abutment

Cantilever fixed partial denture

3D analysis

Terminal abutment stress

Prosthesis deformation

Gap volume

a b s t r a c t

Objective. The purpose of this study was to investigate and compare the load distribu-

tion and displacement of cantilever prostheses with and without glass abutment by three

dimensional finite element analysis. Micro-computed tomography was used to study the

relationship between the glass abutment and the ridge.Methods. The external surface of the maxilla was scanned, and a simplified finite element

model was constructed. The ZX-27 glass abutment and the maxillary first and second pre-

molars were created and modified. The solid model of the three-unit cantilever fixed partial

denture was scanned, and the fitting surface was modified with reference to the created

abutments using the 3D CAD system. The finite element analysis was completed in ANSYS.

Thefit andtotalgap volume between theglassabutmentand dentalmodel weredetermined

by Skyscan 1173 high-energy spiral micro-CT scan.

Results. The results of the finite element analysis in this study showed that the cantilever

prosthesis supported by the glass abutment demonstrated significantly less stress on the

terminal abutment and overall deformation of the prosthesis under vertical and oblique

load. Micro-computed tomography determined a gap volume of 6.74162 mm3.

Significance. By contacting the mucosa, glass abutments transfer some amount of masti-

catory load to the residual alveolar ridge, thereby preventing damage to the periodontalmicrostructures of the terminal abutment. The passive contact of the glass abutment with

the mucosa not only preserves the health of the mucosa covering the ridge but also permits

easy cleaning. It is possible to increase the success rate of cantilever FPDs by supporting the

cantilevered pontic with glass abutments.

2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Corresponding author at: Department of Materials Science and Engineering, The Kroto Research Institute, The University of Sheffield,North Campus, Broad Lane, Sheffield S3 7HQ, UK. Tel.: +44 01142225946; fax: +44 01142225945.

E-mail address: [email protected] (I.U. Rehman).

http://dx.doi.org/10.1016/j.dental.2015.02.003

0109-5641/ 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
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1. Introduction

Because of patient preference, manydentists have used a fixed

partial denture (FPD) with free-end pontics for several years

with low success rate [1]. The estimated 10-year failure rate

is 18.2% for cantilever FPDs. During this period, several bio-

logical, mechanical and technical failures, such as abutmentcrown and/or root fractures, abutment crown loosening, and

fractures of the FPD, are common [2]. Most of these failures are

undiagnosed until there is caries or fracture with pulp involve-

ment causing pain. The principle cause for the high failure

rate in cantilever FPDis because of thecompromised harmony

between the mechanical factors, such as load transfer, and

biological factors, such as periodontal health.

Conventional FPD replacing one or more missing teeth

gains complete support from one or more abutment teeth sit-

uated on both the mesial and distal ends of the edentulous

ridge. In contrast, a cantilever FPD gains support from one end

by one or more abutments and the other end remains unsup-

ported [2]. Because the cantilever FPD is supported at only oneend, the functional load distribution from the cantilevered

pontic to the abutment differs from that of a conventional

FPD. Hence, the success of the treatment depends on the

health and number of abutments supporting cantilever FPD,

the functional load applied on the cantilevered units, the

type of occlusion [36] and oral hygiene [7]. Cantilevered pon-

tics generate tilting and rotational forces on the terminal

abutments, unlike in natural dentition, where the forces are

transferred along the long axis of the tooth [8]. These oblique

forces cause stress-induced microdamage to the supporting

periodontium [9]. This damage is even pronounced when a

cantilever FPD replaces posterior teeth because the muscles of

mastication exert the strongest masticatory load in the poste-rior segment of the dental arch. To reduce this damage, single

cantilevered pontics must be supported by at least two peri-

odontally healthy abutments [3,10].

Placement of one or more implants to support the can-

tilevered end is also an option that is recommended by many

experts [1117]. Proper case selection, implant placement and

prosthesis design based on biological and mechanical aspects

can better distribute the masticatory load and preserve the

health of the abutment [16,17]. However, not all cases can be

treated with implants because a number of factors, such as (i)

medical health of the patient, (ii) morphology of the ridge, (iii)

anatomy of the bone, (iv) age and (v) financial aspects, may

prevent patients from opting for implant treatment. Hence,there is a need to develop a cost-effective and suitable system

that meets these important parameters, and researchers have

developed a glass abutment systemthat will improve theforce

distribution from cantilevered pontics.

Glass abutments are fabricated to rest on the edentulous

ridge to support the cantilevered pontics. By resting on the

ridge, some of the masticatory load generated on the can-

tilevered pontic is transferred to the ridge, thereby reducing

the damage to the abutment caused by vertical and oblique

forces [18]. However, active contact of the glass abutment and

the masticatory forces transferred directly to the ridge can

adversely affect the health of the mucosa over the edentulous

ridge. Therefore, the objective of this research was to study

Table 1 Elastic properties of the materials used for thefinite element analysismodel.

Youngsmodulus (MPa)

Poissons ratio

Cortical bone 1340 0.30

Cancellous bone 150 0.30

Enamel 80, 000 0.30

Dentin 15, 000 0.31

ZX-27 Glass 69, 000 0.19

Nickel chromium alloy 200, 000 0.29

Periodontal ligament 6.9 0.45 [35]

Pulp 5.4 0.44 [35]

Oral mucous membrane 7.5 0.45 [36]

and compare the functional load distribution and displace-

ment of the cantilever FPD with and without glass abutments

using 3D finite element analysis. This analysis was preferred

over 2D analysis because 3D analysis provides an actual rep-

resentation of the stress behavior of the supporting alveolar

bone. Furthermore, for the first time, micro-computed tomo-

graphy (micro-CT) was used to study the relationship betweenthe glass abutment and the ridge.

2. Materials and methods

The external surface of the dry human maxilla, which was

edentulous in the right posterior area, was scanned using a 3D

laser scanner (Exascan, Creaform Inc., rue St-Georges, Levis,

Quebec) to construct a simplified finite element model of the

maxillary bone. The ZX-27 glass abutment and maxillary first

and second molars were created and modified following the

fundamental principles of fixed prosthodontics [19,20] using a

3D CAD system (Catia V5). The modified molars with 3 roots

consisted of three co-axial cylinders. The inner most cylin-der represented the pulp with a diameter of 1 mm, the middle

cylinder represented dentin with a diameter of 2 mm, and the

outer cylinder represented enamel, with a diameter of 1 mm.

The ZX glass abutment was created to rest on the soft tis-

sue adjacent to the maxillary second molar (Fig. 1). The solid

model of the three unit nickel chromium cantilever FPD was

scanned using a 3D laser scanner, and the fitting surface was

modified with reference to the created abutments using a 3D

CAD system (Catia, v5) (Fig. 1). The entire STL (Stereo Lithogra-

phy) file was imported to ANSYS 5.0 (ANSYS, Inc. Southpointe,

Canonsburg, PA). The elastic properties of the cortical bone

[21], cancellous bone [21], enamel [22], dentin [22], pulp, peri-

odontal ligament, oral mucous membrane, glass abutments[23] and cantilever nickel chromium alloy [24] FPD are tab-

ulated in Table 1. The model with the glass abutment had

995,030 nodes and 635,738 elements, and the model without

the glass abutment had 991,894 nodes and 634,039 elements.

The thickness of the gingiva was 2mm, and the thickness of

cortical bone was 3 mm. The finite element model was sub-

jected to simulated masticatory forces with a vertical and

oblique surface load. A vertical static surface load of 448 N [25]

was distributed over and perpendicular to the occlusal table

to simulate the natural functional load along the long axis

of the cantilever FPD. To simulate the lateral functional load

during eccentric mandibular movements, an oblique static

surface load of 300N [26] was distributed at an angle of 45
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Fig. 1 Simplified finite element analysis models.

Fig. 2 Application of vertical and oblique functional loads.


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Fig. 3 Stresses created at the pontic-retainer interface with and without a glass abutment.

to the occlusal table from the lingual direction. Finite element

analysis was conducted with and without glass abutments

to determine the stress distribution and displacement of thecantilever FPD (Fig. 2), the boundary conditions of the pre-

pared abutments, glass abutment and cantilever fixed partial

denture were fixed and constraints were placed on the nodes

located far from the pontic connector area on the mesial and

distal surfaces of the maxillary segment. The applied masti-

catory load was distributed equally throughout the cantilever

FPD. The convergence of the finite element model was exam-

ined at the lateral surface of the maxillary segment on the

surface of the cortical bone.

Furthermore, to study the fit surface and total gap volume

between the glass abutment and dental model, a glass abut-

ment to support the cantilevered maxillary first molar pontic

was fabricated using the ZX-27 attractive glass abutment sys-tem (Hypodent international s.r.o, Capajevova 4, 04011 Kosice,

Slovenska republika). ZX-27 glass abutments are prefabri-

cated, chemically treated, acid resistant glass that melt at

15601600 C. After selecting the suitable size, the glass abut-

ment was mounted on the abutment holder and heated until

it turned red. At 1600 C, the heated abutment was care-

fully pressed over the cast at the predetermined area. Once

the abutment cooled, it was polished using diamond pol-

ishing burs. The fabricated glass abutment and the dental

model were scanned using a Skyscan 1173 high-energy spiral

scan micro CT (BRUKER-MICROCT, Kartuizersweg 3B, Kontich,

Belgium). The X-ray generator of the micro CT was operated

at an accelerated potential voltage of 95kV with a current

of 120A using a 0.25 m m brass filter with a resolution of

68.66 mm pixels. Projection images were recorded in steps of

0.4 from 0 to 360. The three-dimensional reconstructionwas performed using the Insta Recon Software. Beam hard-

ening effect reduction of 30% and 12% ring artifact correction

was used to produce the precise cross-sectional image. The

resulting data set of 66.68 micrometer voxels of each cross

section were analyzed using the CT An (version 1.13.11.0+)

software. The main aim of the scan was to calculate the GAP

distance and gap volume between the glass abutment and

the dental model, which was measured in mm2. The gap dis-

tance was calculated in three standardized directions (left,

mid, right). The 3D visualization was performed using CT VOL

version (2.2.3.0) (Fig. 5).

3. Results

The stresses created at the cantilevered pontic and the distal

most abutment interface and the deformation of the FPD with

and without the glass abutment are presented in Figs. 3 and 4.

The cantilever FPD without the glass abutment had the high-

est stress and deformation.

4. Deformation

After the application of both vertical and oblique loads, the

total deformation was measured at the pontic connector

area. The measured deformation of the cantilevered pontic


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Fig. 4 Total deformation of the cantilevered pontic with and without a glass abutment.

supported by the glass abutment was less than that of pon-

tic without the glass abutment support. After the application

of a vertical load, the pontic supported by the glass abutment

showed deformation of 1.1233mm, whereas the pontic with-out the glass abutment showed a deformation of 1.2266mm.

After the application of an oblique load, the deformation

was 8.5774mm for the pontic with the glass abutment and

9.2381mm for the pontic without the glass abutment.

5. Stresses

Theapplicationof a vertical load resulted in stressof 27.77MPa

on the pontic with a glass abutment, whereas the pontic

without the glass abutment experienced stress of 43.678MPa,

which is approximately 2 times more. The application of an

oblique load created stresses of 34.289MPa on the pontic with

the glass abutment and 53.745MPa on the pontic without theglass abutment, which was also approximately 2 times more.

Micro-computed tomography (micro-CT) images of the

model and glass abutments are shown in Fig. 4. Only the point

contact of the glass abutment with the model was noted. The

gap distance was 0.2mm on the buccal side, 0.4mm on the

lingual side, and in the midsection adjacent to the point con-

tact, the measured gap was 0.1mm. A total gap volume of

6.74162 mm3 was observed.

6. Discussion

The present study employed three dimensional finite element

analyses to determine the nature, direction and amount of

deformation and stress created on terminal abutments. 3D

finite element analysis has been a valuable tool for measur-

ing and visualizing mechanical behavior of cantilever FPD.

However, the use of finite element analysis in this study hassome limitations, including the load application and simula-

tion of the oral environment. The masticatory load from the

tooth alone is duplicated, whereas non-masticatory forces,

such as forces from the tongue and muscles of mastication are

not simulated. Regarding the simulation of the oral environ-

ment, the parameters of the tooth and supporting structures

were considered, whereas the oral temperature and bound-

ary conditions were omitted because the current research is a

simulated in vitro mathematical study.

This studyanalyzedthe effects of vertical andoblique loads

on the deformation of three-unit glass abutment supported

and unsupported cantilever FPD. The results obtained from

these analyses were in agreement with previous studies con-ducted by Romeed et al. [27,28], and Wang et al. [29]. The

maximum stress was observed at the connector area, just

distal to the terminal abutment in both supported and unsup-

ported glassabutment prostheses (Fig. 3). Afterthe application

of a vertical load, greater deformation was observed at the

most distal end of the cantilevered pontic, and after the

application of an oblique load, maximum deformation was

observed in the occlusal thirds of the prostheses (Fig. 4).

However, the deformation and stresses created were less in

the glass abutment supported prostheses than in the unsup-

ported prostheses. This may be due to the difference in the

amount of vertical displacement. The glass abutment pre-

vented further displacement of the cantilevered end resulting


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Fig. 5 Stresses created at root/bone interface.

in lower stresses on the terminal abutments than in unsup-

ported FPD. After the application of both vertical and oblique

loads, the displacement of the prostheses was mainly inthe vertical direction because the cantilevered end remained

unsupported distally. Deformation of the prostheses is the

major factor that determines the success of FPD treatment

[30]. Excessive deformation duringmastication transfers dam-

aging forces to the terminal abutment, aggravates the clinical

symptoms of periodontally compromised abutment teeth and

damages the mucosa covering the edentulous alveolar ridge

at the cantilevered end. The amount of vertical displacement

depends on the number and mesio-distal length of the can-

tilevered pontic; increasingthe number of cantilevered pontics

increases the amount of vertical displacement, and the extent

of displacement may be more when observed clinically than

when measured by finiteelement analyses. Hence, every effortmust be made to limit the displacement of prostheses, espe-

cially in posterior cantilever FPDs.

Simple cantilever FPD can be used to replace anterior teeth

by increasing the number of abutments to provide maxi-

mum support because masticatory forces are minimal in the

anterior segment. In contrast, simply increasing the number

of abutments in the posterior segment does not drastically

improve the success rate because the generated masticatory

load is greater. Yokoyama et al. [31] and Correa et al. [32] rec-

ommended the placement of implants to support cantilevered

pontics through a finite element study because it reduces

the amount of stress created on the supporting abutment.

However, there are several clinical situations where implant

treatment is contraindicated. In such situations, glass abut-

ments serve as an alternative and non-invasive method of

providing support for the cantilevered ponticto limitdeforma-tion under a vertical load, thereby minimizing stresses created

on the terminal abutment. Glass abutments are chemically

treated, biocompatible and fabricated to rest on soft tissues

and can be cemented to cantilevered pontics. This chemically

modified glass abutment can be shaped to any pontic design,

and its smooth, transparent surface not only prevents plaque

accumulation but also enhances esthetics.

However, active contact of the glass abutment and transfer

of masticatory load can have adverse effects on the resorption

pattern of the residual alveolar ridges. Hence, micro-CT anal-

ysis was performed to study the relationship between glass

abutments and residual alveolar ridges. The results of the

micro-CT showed point contact (0.1mm) of the glass abut-ment at the crest of the residual alveolar ridge (Fig. 5). The

glass abutment is cemented to the cantilevered pontic, and if

deformation occurs during mastication, then the glass abut-

ment prevents further displacement of the cantileveredpontic

by contacting the ridge and transferring some of the mastica-

tory forces to the residual alveolar ridge without damaging

the periodontal health of the terminal abutment. Kerenyi per-

formed cytological, histological and elemental analyses of the

oral mucosa of patients with glass abutments and reported

no adverse effects on the oral mucosa. The surface and chem-

ical composition of the glass abutments did not change after

being in the oral cavity for 8 months [33]. Keszthelyi [34] stud-

ied the hemolytic activity of glass abutments on rabbits, and


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Fig. 6 Gap distance and gap volume between the glass abutment and the dentalmodel.

the results of that study showed hemolytic activity below 30%,

which is considered low and non-toxic. Hence,the use of glass

abutments for cantilevered pontics increases the success rate

of cantilevered FPDs by reducing the vertical displacement of

the cantilevered pontics and reducing stress on the terminal

abutment (Fig. 6).

7. Conclusion

Within the limitations of this study, we determined that glass

abutment supported cantilever FPDs significantly reduce the

amount of deformation of cantilever pontics under vertical

and oblique masticatory forces. Glass abutments contact the

mucosa and transfer some of the masticatory load to theresidual alveolar ridge, thereby preventing damage to the

periodontal microstructures of the terminal abutment. The

passive contact of the glass abutment with the mucosa not

only preserves the health of the mucosa covering the ridges

but also permits easy cleaning. It is possible to increase the

success rate of cantilever FPDs by supporting the cantilevered

pontics with glass abutments.

However, finite elemental analysis is a simulated in vitro

mathematical study, further research work is required to vali-

date the experiment using suitable devise such as strain

gauges. In vivo clinical study on human patients is recom-

mended to evaluate the acceptability and biocompatibility of

the glass abutment.

Acknowledgement

We would like to extend our appreciation to the Research

Centre, College of Applied Medical Sciences and Deanship of

Scientific Research at King Saud University for funding this

research.

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