DESIGN AND SIMULATION OF A DENTAL IMPLANT FOR THE INDONESIAN

POPULATION

MOHD IQMAL BIN MAMAT

A project report submitted in partial fulfilment of the

requirements for the award of the degree of

Master of Science (Mechanical Engineering)

Faculty of Mechanical Engineering

Universiti Teknologi Malaysia

JULY 2017

lll

For you,

Mother and Father.

iv

ACKNOWLEDGEMENT

First and foremost, I would like to thank my Master Project main supervisor, Dr. Ardiyansyah Shahrom for his constant guidance, encouragement, and support throughout the entire duration of the project. His patience towards me is what enables me to survive, and most importantly complete this project within two semesters. I would also like to extend my sincere gratitude to Dato’ Prof. Dr. Ir. Hj. Mohamed Rafiq bin Dato’ Abdul Kadir for being the person who introduced me to the world of biomechanics. Both of you are the giants whose shoulders I stand on.

To the people of the Sports Innovation and Technology Center (SITC), Faculty of Biosciences and Medical Engineering (FBME) UTM, thank you for all your support these past one and a half years. Not forgetting the people of the Medical Implant and Technology Group (MEDITEG), FBME UTM, you guys have helped me through some of the most difficult times in my life. For that, you will always have my gratitude.

A special thank you to both my parents, who have been supporting me throughout my Master’s degree journey every step of the way. This is all for you. Last but not least, thank you to all parties who have helped me in progression of this project from the beginning to the very end, either directly or indirectly. To the Almighty Allah SWT, thank You for granting me the strength and willpower necessary to see this project through to its completion.

v

ABSTRACT

The growing senior citizen population of Indonesia has led to an increase in

cases of edentulism amongst the population there. Current dental implants are

unsuitable due to morphological differences in the oral anatomy between people of

European ancestry and Indonesian ancestry. This fuels the need for a dental implant to

be designed specifically for the Indonesian population in mind. The objectives of this

study are to design a new dental implant specifically suitable for the average

Indonesian woman and to study its mechanical behavior under normal physiological

loading conditions through the use of nonlinear finite element analysis (FEA) software

MSC Marc™. The size of the dental implant is determined through statistical analysis

of anthropometric data from five Indonesian women with ages from 46 to 59 years old.

Four conceptual designs are generated, and only one is selected as the final design. A

three - dimensional (3 - D) model of the dental implant is created by using the

computer - aided design software (SolidWorks™). A 3 - D model of the posterior

mandible is created by using CT - scan images. These two 3 - D models are combined

inside an FEA software and their combined mechanical behavior is simulated. The

results show that the equivalent von Mises stress on the implant is within acceptable

limits. Furthermore, other results such as the maximum principal stress on the bone,

maximum compressive stress on the bone, and maximum shear stress on the bone,

indicates that a dental implant has been designed for the average Indonesian population

which can perform reasonably well under normal physiological loading conditions

with minimal risk of failure. Further studies are needed to verify this, but for now, the

results show potential.

vi

ABSTRAK

Populasi warga emas yang sedang meningkat di Indonesia telah menyebabkan

peningkatan dalam kes - kes edentulism. Implan pergigian yang terdapat di pasaran

ketika ini dikatakan kurang sesuai untuk mereka kerana wujudnya perbezaan

morfologi di dalam anatomi oral di antara orang yang berketurunan Eropah dan

Indonesia. Hal ini mencetuskan lagi keperluan untuk mereka bentuk satu implan

pergigian yang direka khusus untuk warga emas Indonesia. Objektif - objektif kajian

ini adalah untuk mereka bentuk implan pergigian yang baharu yang sesuai untuk

digunakan oleh perempuan Indonesia yang biasa serta untuk mengkaji tingkah laku

mekanikal implan tersebut di dalam keadaan bebanan fisiologi yang normal melalui

perisian analisa unsur terhingga (FEA) tak linear MSC Marc™. Saiz implan pergigian

itu ditentukan melalui analisa statistical ke atas data antropometri daripada lima orang

wanita Indonesia yang berumur di antara 46 hingga 59 tahun. Empat reka bentuk

konseptual yang dijana, dan hanya satu yang dipilih sebagai reka bentuk akhir. Satu

model tiga dimensi (3 - D) implan pergigian itu telah dicipta dengan menggunakan

perisian reka bentuk bantuan computer (CAD) SolidWorks™. Satu model 3 - D

rahang bawah posterior telah dicipta berdasarkan imej - imej C T - scan. Kedua - dua

model 3 - D tadi dicantum di dalam sebuah perisian FEA dan tingkah laku mekanikal

mereka disimulasikan. Keputusan kajian ini menunjukkan bahawa tegasan von Mises

setara yang dikenakan terhadap implan itu masih lagi berada pada julat yang boleh

diterima. Keputusan - keputusan lain seperti tegasan principal maksimum pada tulang,

tegasan mampatan pada tulang, dan tegasan ricih pada tulang menunjukkan bahawa

sebuah implan pergigian yang boleh bertindak dengan baik di dalam keadaan bebanan

fisiologi biasa dengan peluang kegagalan yang minima yang boleh digunakan oleh

penduduk purata Indonesia telah berjaya dicipta. Kajian selanjutnya diperlukan untuk

membuktikan kesahihan pernyataan ini, tetapi keputusan kajian ini amat

memberangsangkan.

vii

TABLE OF CONTENTS

TITLECHAPTER PAGE

DECLARATION 11

DEDICATION 111

ACKNOWLEDGEMENT 1v

ABSTRACT v

ABSTRAK vi

TABLE OF CONTENTS v11

LIST OF TABLES X1

LIST OF FIGURES X11

LIST OF ABBREVIATIONS Xv

LIST OF SYMBOLS Xv1

LIST OF APPENDICES Xv11

1 INTRODUCTION

1.1 Overview of the Study 1

1.2 Present Context: The Economics of Dental Implants 1

1.3 Problem Statement: Suitability of Dental Implants for 3

the Average Indonesian Population

1.4 Objectives of Study 4

1.5 Scope of Study 4

1.6 Significance of Study 5

1.7 Limitations of Study 5

viii

2 LITERATURE REVIEW

2.1 Introduction 6

2.2 Anthropometry: A General Overview 6

2.3 Anatomy of the Oral Cavity 9

2.3.1 The Mandible 11

2.3.2 The Teeth 12

2.4 Racial Differences in Mandibular Anthropometry 15

2.5 Rationale for Dental Implants 16

2.5.1 The Effects of an Aging Population 17

2.5.2 Biological Advantages of Dental Implants 18

2.6 Modern Dental Implantology: An Overview 22

2.7 Types of Dental Implants 25

2.7.1 Subperiosteal implants 25

2.7.2 Intramucosal implants 26

2.7.3 Transosteal implants 27

2.7.4 Endosteal implants 28

2.8 The Finite Element Method: Common Concepts and 29

Terminologies

2.9 Clinical Biomechanics of Dental Implants 33

2.10 Factors Influencing Dental Implant Design: Comparison of 34

Various Literature

2.10.1 Implant length 35

2.10.2 Implant diameter 36

2.10.3 Implant geometry 36

2.10.4 Implant thread configuration 38

2.10.4.1 Thread pitch 39

2.10.4.2 Thread helix angle 39

2.10.4.3 Thread width and depth 40

2.11 Summary 41

3 RESEARCH METHODOLOGY

3.1 Introduction 42

3.2 Phase One: Morphological Study of Oral Cavity Images 43

3.2.1 Statement of Ethics 44

3.3 Phase Two: Design of Dental Implants 45

3.3.1 Product Discovery 45

3.3.2 Product Definition 47

Quality Function Deployment (QFD) for Dental 483.3.3

Implant Design

3.3.4 Conceptual Design of Dental Implants 53

3.3.4.1 Concept 1 - Angular abutment dental 53

implant

3.3.4.2 Concept 2 - Porous metal implant body 54

3.3.4.3 Concept 3 - Serrated thread dental 55

implant

3.3.4.4 Concept 4 - Variable thread dental 55

implant

3.4 Phase Three: Three - Dimensional (3 - D) Modeling of the 58

Mandible

3.5 Phase Four: Nonlinear Finite Element Analysis 60

3.5.1 Pre - Simulation 60

3.5.2 Simulation 64

3.5.2.1 Geometric Properties 66

3.5.2.2 Material Properties 66

3.5.2.3 Contact Properties 67

3.5.2.4 Boundary Conditions 67

3.5.2.5 Loadcases 68

3.5.3 Post - Simulation 69

3.6 Summary 69

ix

4 RESULTS AND DISCUSSION

4.1 Introduction 70

4.2 Statistical Analysis of Anthropometric Data 70

4.3 Final Design of Dental Implant 71

4.4 Mesh Configuration of the Implant - Mandible Model 75

4.5 Mechanical Behaviour of the Designed Dental Implant 76

4.5.1 Equivalent von Mises Stress 76

4.5.2 Maximum Principal Stress 80

4.5.3 Maximum Compressive Stress 81

4.5.4 Maximum Shear Stress 83

4.6 Corroboration with External Literature 84

4.7 Summary 85

5 CONCLUSION AND RECOMMENDATIONS

5.1 Overall Summary and Conclusion of Research 87

5.2 Recommendations for Future Work 88

REFERENCES 89

APPENDICES 97

x

xi

TABLE NO. TITLE PAGE

2.1 Variations in craniofacial traits for average members of three 8

different ancestries

3.1 Step 3 of QFD for dental implant 49

3.2 Step 5 of QFD for dental implants 51

3.3 Step 6 of QFD for dental implants 52

3.4 Step 7 of the QFD for dental implants 53

3.5 Design score for each of the four conceptual designs. Each concept 57

has two scores, the assigned score St and the normalized score

3.6 Mechanical properties of the materials used in the simulation 66

3.7 Interfacial properties of the contact bodies in this simulation 67

4.1 Table showing the distance between the alveolar crest and the 70

mandibular canal, d (mm) and the thickness of the alveolar bone, t

(mm)

4.2 Comparison of the maximum values of various stress fields as 85

obtained in this study with that obtained by other research

LIST OF TABLES

xii

FIGURE NO.

1.1

2.1 (A)

2.1 (B)

2.2 (A)

2.2 (B)

2.2 (C)

2.3 (A)

2.3 (B)

2.4

2.5

2.6

2.7

2.8

LIST OF FIGURES

TITLE

Child mortality rates in United Kingdom (in purple) and

Indonesia (in blue) in the 20th century and the early 21st -

century, expressed as the number of children per 1000 live

births who die before reaching the age of 5

Position of the oral cavity in relation to other facial cavities

Oral vestibule and oral cavity proper

Superior view of the mandible

Lateral view of the mandible

Medial view of the mandible

Adult upper and lower permanent teeth

Deciduous (“baby”) teeth

Cross - sectional view of a human tooth

Graph of the average lifespan of a human being from the

year 1500 BC to 2000 AD

A dentate mandible on the left and a long - term edentulous

mandible on the right. Note the amount of bone loss in

height.

Ridge resorption in the maxilla and the mandible

Profile view of a patient who is edentulous in the maxilla

region. Note the maxillary bone loss effect on the lack of

vermilion border of the lip and deep labial folds. The lower

PAGE

2

11

11

12

12

12

14

14

15

18

20

20

21

2.9

2.10

2.11

2.12

2.13

2.14

2.15

2.16

2.17

2.18

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

3.10

xiii

lip has a normal vermilion border and the muscles to the

anterior lower jaw are still attached, providing a normal

contour.

A typical self - tapping implant 23

Diagram of a typical dental implant. The crown (unlabelled)25

is designed to mimic natural tooth

Subperiosteal (ramus frame) implant 26

Patent diagram of intramucosal implants 27

Transosteal implant, as installed in the mandible 28

A cluster of finite element with nodes 31

The direction of forces generated at the implant and bone 33

interface resulting from axial loading

The three planes of the oral cavity, along with their 34

associated forces

Common geometries for dental implants 37

Various thread configuration parameters of a dental 38

implant

Overall research methodology flowchart for this study 42

Design framework used in this study 45

The QFD diagram, also known as the ‘house of quality’ 47

Dental implant concept 1 54

Dental implant concept 2 54

Dental implant concept 3 55

Dental implant concept 4 55

Final remeshed model of the mandible used in this study 60

Deformed mesh at the mouth of the hole created due to the 62

Boolean subtraction operation

Repaired mould for the implant - mandible model, with all 63

the nodes being coincident and non - self - intersecting.

xiv

3.11 Framework for the simulation phase 65

3.12 Boundary conditions imposed on the model 68

4.1 Isometric view of the designed dental implant 72

4.2 Isometric view of the implant body 72

4.3 Isometric view of the abutment 73

4.4 Schematics of the dental implant showing the relevant 74

dimensions

4.5 Mesh configuration of the combined implant body - 76

abutment model

4.6 Equivalent von Mises stress field for the abutment 77

4.7 Equivalent von Mises stress field for the implant body 78

4.8 Areas of stress concentration at the neck of the implant body 79

4.9 Maximum principal stress field at the mandible 80

4.10 Maximum compressive stress field on the mandible 82

4.11 Maximum compressive stress field at the site of83

implantation

4.12 Shear stress field at the installation site of the implant 84

xv

LIST OF ABBREVIATIONS

3 - D Three - dimensional

BIC Bone - implant contact

CAD Computer - aided design

CT Computerized tomography

DICOM Digital Imaging and Communication in Medicine

FEA Finite element analysis

FEM Finite element method

ROI Region of interest

STL Stereolithographic

USD US Dollars

xvi

LIST OF SYMBOLS

9 (x y ) field variable at spatial co - ordinate (x, y)

B transversal diameter (breadth) of the skull

d distance between the alveolar crest and mandibular canal

dmean mean distance between the alveolar crest and mandibular canal

IC cephalic index

L anteroposterior diameter (length) of the skull

Na node a (referring to a particular node)

t thickness of the alveolar bone

tmean mean thickness of the alveolar bone

LIST OF APPENDICES

APPENDIX

A

B

C

xvii

TITLE PAGE

Anonymized anthropometric data from five female Indonesian 97

patients

Mean and standard deviation calculations for anthropometric 99

data

Three - view schematic of designed dental implant 102

CHAPTER 1

INTRODUCTION

1.1 Overview of the Study

This chapter serves to provide a general overview on the themes of this

research. It begins by describing a picture of the supply and demand of dental implants

from an economic point of view and progresses to explain the inherent need to design

a new implant specifically for the Indonesian population. Next, the objectives of this

research, along with its scope is stated, before finally closing with a statement on the

limitations of this research as a whole.

1.2 Present Context: The Economics of Dental Implants

The average lifespan for the average human being in the 21st century is now

longer than it used to be compared to any other time since the dawn of human

civilization. To put this into perspective, Roser (2016) wrote that a 5 - year old child

could expect to live an average of 55 years in 1845 compared to 82 years in 2016,

demonstrating an increase of lifespan by 27 years within a time interval of 171 years.

This pattern is followed by most countries, as shown in Figure 1.1, which shows the

child mortality rate in United Kingdom and Indonesia.

2

Child mortalityNumber of children per 1,000 live births who die before reaching the age of 5.

Qur World in Data

Indonesia United Kingdom + Add country

Source: Our World in Data based on Human Mortality Database and UN Child Mortality Estimates

CHART

OurWorkJlnData.org/chikl-mtjrtality/ ■ CC BY-SA

DATA SOURCES A < * '

Figure 1.1 Child mortality rates in United Kingdom (in purple) and Indonesia (in

blue) in the 20th century and the early 21st - century, expressed as the number of

children per 1000 live births who die before reaching the age of 5 (Roser, 2016).

The 5 - year benchmark is used because average lifespans are calculated

without taking child mortality rate into account. It remained obvious that these

improvements do not happen by mere coincidence, but through the various

improvements made in the field of medicine. One of the advances in medical

technology which has contributed greatly to this increase is the development of dental

implantology by a Swedish physician, Dr. Per - Ingvar Branemark.

As the global population continue to possess a longer lifespan, there will

consequently be an increase in the demand on the ability of the dental profession to

maintain oral health, whose scope also includes effectively treating the edentulous

population. Edentulism is defined by Gilchrist (2016) to be ‘a condition where a person

experiences a complete loss or partial loss of teeth’.

Although there is speculation that the rate of edentulism amongst the

population is dropping, the increased number of people living past the onset of the

elderly age offsets that number, thus resulting in an increase in the number of patients

experiencing edentulism. In fact, the total number of edentulous arches is expected to

3

reach 37.9 million by the year 2020. Consequently, this results in a rise in the number

of patients requiring at least one full arch of tooth replacement. The global market for

dental implants is currently estimated to be worth 3.4 billion USD, with expected

growth in the coming years (Turkyilmaz and Soganci, 2015).

From an economic point of view, one of the factors affecting the feasibility of

a dental implant is its manufacturing cost. The manufacturing cost of a dental implant

depends on a few other factors such as the price of materials needed to fabricate the

dental implant and the complexity of the design of the dental implant. The second

factor, design, is to be the main focus of this research.

1.3 Problem Statement: Suitability of Dental Implants for the Average

Indonesian Population

There are many factors affecting the suitability of a dental implant in a patient.

This suitability, which is measured by the primary stability of the implant, is important

as it provides an indicator for the functional lifespan of a dental implant. The primary

stability of a dental implant is the mechanical stability obtained by the implant

immediately after insertion. For the ideal dental implant, having a good primary

stability means being able to provide strength, rigidity and resistance to movement of

the implant before the gum tissue begins to heal (Elias et al., 2012).

The primary stability of the dental implant is very much affected by the design

of the implant (Gehrke and Marin, 2015, Elias et al., 2012). The secondary stability is

provided by osseointegration and requires the optimal amount of bone - implant

contact (BIC) without the interposition of connective tissue. Both of these stabilities

constitute the overall stability of the implant, and thus, contribute to its functional

lifespan. Although there are studies which focus solely on studying the design and

stability of dental implants, both by using simulation and experimental data (Wang et

al., 2016, Bicudo et al., 2016), the data is collected based on the anthropometric data

of the people residing in that particular region or country. Despite the similarities found

in the overall pattern of mechanical behaviour of dental implants regardless of the

4

anthropometric data of the subjects used to conduct the research in these papers, it

becomes problematic when individual patients are considered.

Consider the edentulous Indonesian population, for instance. Due to distinct

anthropometric differences between the Indonesian population and the African or

European population, the dental implants manufactured in those countries, are

unsuitable for their use. This results in a host of problems for the average Indonesian.

To date, there have been no studies concentrating solely on the stability of dental

implants in people of Indonesian descent. The particular focus of this research is on

the design of a dental implant and the simulated mechanical behaviour of the designed

implant which uses anthropometric data from the average Indonesian population.

1.4 Objectives of Study

There are two objectives which this study will hope to achieve, namely:

(1) To design a dental implant based on anthropometric data from the average

Indonesian population.

(2) To study the mechanical behaviour of the designed dental implant by using

finite - element analysis.

1.5 Scope of Study

The scope of this study is as follows:

(1) Computer - assisted design (CAD) of a new dental implant by using

Solidworks™.

(2) Sizing of the dental implant through statistical analysis of anthropometric

data from five patients.

(3) Construction of a 3 - dimensional (3 - D) model of a mandible from data

taken from Universitas Airlangga Dental Hospital, Indonesia.

(4) Finite element analysis (FEA) of the combined implant - mandible model.

5

1.6 Significance of Study

This study will pave the way for the development of a dental implant which

can be suitably used by the average Indonesian woman. The suitability here will be

determined based on morphological characteristics, which will directly influence the

initial stability of the implant. Through the results of this study, it is hoped that a locally

- produced implant can be manufactured, which will then reduce the cost of

expenditure of edentulous patients in Indonesia.

1.7 Limitations of Study

There are two limitations in this study, and they are as follows:

(1) The sample size is made up of only six women, with an age range of 46 to

59 years old.

(2) The model of the mandible is developed to cover only the region of interest

i.e. the molar region.

The first limitation is due to the difficulty in securing medical consent when

using biological data from living persons. Only six patients consented to having their

data used for this study. The second limitation is due to the redundancy involved in

developing models that are larger in size than necessary. If a larger model is developed,

not only it will have no discernible effect on the final results (since only the area in the

immediate vicinity of the dental implant will experience noteworthy changes), it will

also greatly increase the computation time since a greater number of elements and

nodes will be present.

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