Finite element analysis of various implant configurations using zygomatic and pterygoid implants in the rehabilitation of the atrophic maxilla

Yıl 2025, Cilt: 6 Sayı: 4, 409 - 415, 31.08.2025

Oğuzhan Tapçı Ferhat Ayrancı , Eren Toğaç

https://doi.org/10.47582/jompac.1752406

Öz

Aims: This study aimed to evaluate the biomechanical behavior of different implant-supported rehabilitation concepts involving zygomatic and pterygoid implants in the atrophic maxilla using finite element stress analysis (FESA).
Methods: A 3D finite element model of an atrophic maxilla was generated from CT data and restored using three different implant configurations, including zygomatic and pterygoid implants. Linear static FESA was performed under vertical loading (150 N) in both anterior (tooth 11) and posterior (tooth 16) regions. Von Mises and principal stress values were calculated for implants, abutments, prosthetic substructure, and cortical and cancellous bone.
Results: Under anterior loading, the highest von Mises stress on implants and abutments was observed in model III (56.07 MPa), while model II (27.937 MPa) showed the lowest. Under posterior loading, the highest stress on implants was recorded in model II (80.475 MPa), and the lowest in model III (31.123 MPa). Stress distribution in bone tissues varied across models, with model I generally showing the highest principal stress under posterior loading, and model III the lowest. The results highlighted that different implant configurations lead to significant variations in stress patterns.
Conclusion: Among the evaluated configurations, model II provided superior biomechanical performance, suggesting that the implant combination in this model may offer a more favorable stress distribution in the prosthetic rehabilitation of the atrophic maxilla. These findings underscore the importance of implant design and placement strategy, which can be optimized using FESA prior to clinical application.

Anahtar Kelimeler

Atrophic maxilla , zygomatic implants , pterygoid implants , finite element analysis , biomechanical stress , implant supported prosthesis

Destekleyen Kurum

Ordu University Scientific Research Projects Coordination Unit

Proje Numarası

project number B-2430.

Atrofik maksillanın rehabilitasyonunda zigomatik ve pterigoid implantların kullanıldığı farklı implant konfigürasyonlarının sonlu elemanlar analizi ile incelenmesi

Öz

Amaç:
Bu çalışmanın amacı, atrofik maksillanın rehabilitasyonunda zigomatik ve pterigoid implantları içeren farklı implant destekli protez konfigürasyonlarının biyomekanik davranışını sonlu elemanlar analizi (SEA) kullanarak değerlendirmektir.
Gereç ve Yöntem:
Atrofik maksillanın üç boyutlu sonlu eleman modeli, bilgisayarlı tomografi (BT) verilerinden oluşturulmuş ve zigomatik ve pterigoid implantları içeren üç farklı implant konfigürasyonu ile restore edilmiştir. Anterior (diş 11) ve posterior (diş 16) bölgelerde 150 N’lik vertikal yükleme altında lineer statik SEA gerçekleştirilmiştir. İmplantlar, abutmentlar, protez altyapısı, kortikal ve süngerimsi kemik için Von Mises ve asal gerilme (principal stress) değerleri hesaplanmıştır.
Bulgular:
Anterior yükleme altında, implantlar ve abutmentlar üzerindeki en yüksek Von Mises gerilmesi Model III’te, en düşük gerilme ise Model II’de gözlenmiştir. Posterior yükleme altında ise en yüksek implant gerilmesi Model II’de, en düşük gerilme Model III’te kaydedilmiştir. Kemik dokularındaki gerilme dağılımı modellere göre değişkenlik göstermiştir; posterior yükleme altında en yüksek asal gerilme genellikle Model I'de, en düşük ise Model III’te saptanmıştır. Bu sonuçlar, farklı implant konfigürasyonlarının gerilme dağılımı üzerinde önemli farklılıklara yol açtığını ortaya koymuştur.
Sonuç:
Değerlendirilen konfigürasyonlar arasında, Model II en iyi biyomekanik performansı göstermiştir. Bu modeldeki implant kombinasyonu, atrofik maksillanın protetik rehabilitasyonunda daha avantajlı bir gerilme dağılımı sağlayabilir. Elde edilen bulgular, klinik uygulama öncesinde implant tasarımı ve yerleşim stratejisinin SEGA ile optimize edilmesinin önemini vurgulamaktadır.

Anahtar Kelimeler

Atrofik maksilla , zigomatik implant , pterigoid implant , sonlu elemanlar analizi , biyomekanik gerilme , implant destekli protez.

Proje Numarası

project number B-2430.

Kaynakça

• Dalgorf D, Higgins K. Reconstruction of the midface and maxilla. Curr Opin Otolaryngol Head Neck Surg. 2008;16(4):303-311. doi:10.1097/MOO.0b013e328304b426
• Kühnel TS, Reichert TE. Trauma of the midface. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc06. doi:10.3205/CTO 000121
• Zielinski R, Okulski J, Piechaczek M, et al. Five-year comparative study of zygomatic and subperiosteal implants: clinical outcomes, complications, and treatment strategies for severe maxillary atrophy. J Clin Med. 2025;14(3):661. doi:10.3390/JCM14030661
• Cebrián Carretero JL, Del Castillo Pardo de Vera JL, Montesdeoca García N, et al. Virtual surgical planning and customized subperiosteal titanium maxillary implant (CSTMI) for three dimensional reconstruction and dental implants of maxillary defects after oncological resection: case series. J Clin Med. 2022;11(15):4594. doi:10.3390/JCM11154594
• Birgfeld CB, Mundinger GS, Gruss JS. Evidence-based medicine: evaluation and treatment of zygoma fractures. Plast Reconstr Surg. 2017; 139(1):168e-180e. doi:10.1097/PRS.0000000000002852
• Muñoz DG, Aldover CO, Zubizarreta-Macho Á, et al. Survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review and meta-analysis. Biology. 2021;10(7):601. doi:10.3390/BIOLOGY 10070601
• Chrcanovic B, Albrektsson T, Wennerberg A. Bone quality and quantity and dental implant failure: a systematic review and meta-analysis. Int J Prosthodont. 2017;30(3):219-237. doi:10.11607/IJP.5142
• Küçükkurt S. Sonlu elemanlar stres analiz yöntemi ve dental implantoloji ile ilgili yapılan araştırmalar. Ata Diş Hek Fak Derg. 2019;29(4):701-710. doi:10.17567/ataunidfd.328138
• Akbaş M, Akbulut MB, Belli S. Sonlu elemanlar stres analizi ve endodontide kullanımı. EurJ Res Dent. 2021;5(2):85-94. doi:10.29228/erd.15
• Alberto LHJ, Griggs JA, Roach MD, et al. Biomechanical assessment of zygomatic implants in clinical rehabilitation scenarios: a finite element and fatigue analysis. Dent Mater. 2025;41(6):679-689. doi:10.1016/J.DENTAL.2025.03.006
• Tezerişener HA, Özalp Ö, Altay MA, Sindel A. Comparison of stress distribution around all-on-four implants of different angulations and zygoma implants: a 7-model finite element analysis. BMC Oral Health. 2024;24(1):176. doi:10.1186/s12903-023-03761-x
• Geng JP, Tan KBC, Liu GR. Application of finite element analysis in implant dentistry: a review of the literature. J Prosthet Dent. 2001;85(6): 585-598. doi:10.1067/mpr.2001.115251
• Menicucci G, Mossolov A, Mozzati M, Lorenzetti M, Preti G. Tooth–implant connection: some biomechanical aspects based on finite element analyses. Clin Oral Implants Res. 2002;13(3):334-341. doi:10.1034/j.1600-0501.2002.130315.x
• Ishak MI, Abdul Kadir MR, Sulaiman E, Abu Kasim NH. Finite element analysis of different surgical approaches in various occlusal loading locations for zygomatic implant placement for the treatment of atrophic maxillae. Int J Oral Maxillofac Surg. 2012;41(9):1077-1089. doi:10.1016/j.ijom.2012.04.010
• Romeed SA, Hays RN, Malik R, Dunne SM. Extrasinus zygomatic implant placement in the rehabilitation of the atrophic maxilla: three-dimensional finite element stress analysis. J Oral Implantol. 2015;41(2): e1-e6. doi:10.1563/AAID-JOI-D-12-00276
• Helkimo E, Carlsson GE, Helkimo M. Bite force and state of dentition. Acta Odontol Scand. 1977;35(6):297-303. doi:10.3109/00016357709064128
• Haraldson T, Carlsson GE. Bite force and oral function in patients with osseointegrated oral implants. Eur J Oral Sci. 1977;85(3):200-208. doi:10. 1111/j.1600-0722.1977.tb00554.x
• Ayali A, Altagar M, Ozan O, Kurtulmus-Yilmaz S. Biomechanical comparison of the All-on-4, M-4, and V-4 techniques in an atrophic maxilla: a 3D finite element analysis. Comput Biol Med. 2020;123:103880. doi:10.1016/J.COMPBIOMED.2020.103880
• Dayan SC, Geckili O. The influence of framework material on stress distribution in maxillary complete-arch fixed prostheses supported by four dental implants: a three-dimensional finite element analysis. Comput Methods Biomech Biomed Engin. 2021;24(14):1606-1617. doi:10.1080/10255842.2021.1903450
• Ozzo S, Kheirallah M. The efficiency of two different synthetic bone graft materials on alveolar ridge preservation after tooth extraction: a split-mouth study. BMC Oral Health. 2024;24(1):1-8. doi:10.1186/S12903-024-04803-8/FIGURES/4
• Choi Y, Cheong J, Song Y, et al. Moldable and particulate bone material in alveolar ridge preservation: a multicenter randomized controlled trial. Clin Implant Dent Relat Res. 2025;27(2):e70011. doi:10.1111/CID. 70011
• Parhiz A, Nourishirazi R, Asadi A, Karimpour M. Finite element assessment of a novel patient-specific mandibular implant for severely atrophic ridge. Biomed Res Int. 2024;2024:9735427. doi:10.1155/2024/ 9735427
• Acocella A, Sacco R, Niardi P, Agostini T. Early implant placement in bilateral sinus floor augmentation using iliac bone block grafts in severe maxillary atrophy: a clinical, histological, and radiographic case report. J Oral Implantol. 2009;35(1):37-44. doi:10.1563/1548-1336-35.1.37
• Tamer Y, Somay D, Pektaş ZÖ. Otojen iliak kemikle greftlenen atrofik maksillanın 4 implant üstü zirkonyum sabit protezle rekonstrüksiyonu: olgu sunumu. Selcuk Dent J. 2017;4(2):84-88. doi:10.15311/1441.330625
• Ömezli MM, Ertaş Ü. Zigoma implantlari. Ata Diş Hek Fak Derg. 2015; 10(10):190-195. doi:10.17567/dfd.25045
• Moraschini V, de Queiroz TR, Sartoretto SC, de Almeida DCF, Calasans-Maia MD, Louro RS. Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow-up period of at least 5 years: a systematic review and meta-analysis. Clin Implant Dent Relat Res. 2023;25(1):177-189. doi: 10.1111/CID.13153
• Esposito M, Davó R, Marti-Pages C, et al. Immediately loaded zygomatic implants vs conventional dental implants in augmented atrophic maxillae: 4 months post-loading results from a multicentre randomised controlled trial. Eur J Oral Implantol. 2018;11(1):11-28.
• Davó R, Felice P, Pistilli R, et al. Immediately loaded zygomatic implants vs conventional dental implants in augmented atrophic maxillae: 1-year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implantol. 2018;11(2):145-161.
• Curi MM, Cardoso CL, Ribeiro K de CB. Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years. Int J Oral Maxillofac Implants. 2015;30(2):378-383. doi:10.11607/JOMI.3665
• Araujo RZ, Santiago Júnior JF, Cardoso CL, Benites Condezo AF, Moreira Júnior R, Curi MM. Clinical outcomes of pterygoid implants: systematic review and meta-analysis. J Craniomaxillofac Surg. 2019; 47(4):651-660. doi:10.1016/J.JCMS.2019.01.030
• Wu J, Liu K, Li M, Zhu Z, Tang C. Clinical assessment of pterygoid and anterior implants in the atrophic edentulous maxilla: a retrospective study. Hua Xi Kou Qiang Yi Xue Za Zhi. 2021;39(3):286-292. doi:10.7518/HXKQ.2021.03.007
• Signorini L, Faustini F, Samarani R, Grandi T. Immediate fixed rehabilitation supported by pterygoid implants for participants with severe maxillary atrophy: 1-year postloading results from a prospective cohort study. J Prosthet Dent. 2021;126(1):67-75. doi:10.1016/J.PROSDENT.2020.04.005
• D’Amario M, Orsijena A, Franco R, Chiacchia M, Jahjah A, Capogreco M. Clinical achievements of implantology in the pterygoid region: a systematic review and meta-analysis of the literature. J Stomatol Oral Maxillofac Surg. 2024;125(12 Suppl 2):101951. doi:10.1016/J.JORMAS. 2024.101951
• Cea-Arestín P, Bilbao-Alonso A, Hernández-Deoliveira M. Retrospective study of a serie of pterygoid implants. Med Oral Patol Oral Cir Bucal. 2024;29(5):e650-e654. doi:10.4317/MEDORAL.26633
• Wilkirson E, Chandran R, Duan Y. Rehabilitation of atrophic posterior maxilla with pterygoid implants: a 3D finite element analysis. Int J Oral Maxillofac Implants. 2021;36(3):e51-e62. doi:10.11607/JOMI.8185