Stress analysis of effects of nonrigid connectors on fixed partial dentures with pier abutments

Selcuk Oruc, DDS, PhD,a Oguz Eraslan, DDS, PhD,b H. Alper Tukay, DDS, PhD,c and Arzu Atay, DDS, PhDd Selcuk University, Faculty of Dentistry, Konya, Turkey; Gulhane Military Medicine Academy, Istanbul, Turkey
Statement of problem. In some patients, the pattern of missing teeth may require the use of a fixed partial denture (FPD) with an intermediate pier abutment. Information is needed regarding the biomechanical behavior and the position of a nonrigid connector for this treatment option. Purpose. The purpose of this study was to evaluate, by means of finite element method (FEM), the effects of rigid and nonrigid design types on stress distribution for 5-unit FPDs with pier abutments. Material and methods. A 3-dimensional cross-section FEM model (SAP 2000) simulating a 5-unit metal ceramic FPD with a pier abutment with rigid or nonrigid designs (connector location at the mesial region of the second molar, at the distal region of the second premolar, at the mesial region of the second premolar, and at the distal region of the canine) was developed. In the model, the canine, second premolar, and second molar served as abutments. A supporting periodontal ligament and alveolar bone (cortical and trabecular) were modeled. A 50-N static vertical occlusal load was applied on the cusp of each abutment to calculate the stress distributions. Three different types of load were evaluated: loading of all cusps to simulate maximum centric occlusion contacts, loading of the canine to simulate a single anterior contact, and loading of the second molar to simulate a posterior contact. Results. The analysis of the von Mises stress values revealed that maximum stress concentrations were located at the load areas for all models. Also, for all models, the highest stress values were located at connectors and cervical regions of abutment teeth, especially at the pier abutment. Conclusions. The area of maximum stress concentration at the pier abutment was decreased by the use of a nonrigid connector at the distal region of the second premolar. (J Prosthet Dent 2008;99:185-192)

Clinical Implications

Because the pier abutment used in rigid FPDs can act as a fulcrum, the restoration of a terminal abutment may become loose. When fabricating a 5-unit FPD from the maxillary canine to second molar with a pier abutment, the use of a nonrigid connector at the distal of the second premolar may reduce potentially excessive stress concentration on the pier abutment.

Funded by the Selcuk University Research Projects Council (BAP). Professor, Gulhane Military Medicine Academy. Research Assistant, Selcuk University, Faculty of Dentistry, Department of Prosthodontics. c Assistant Professor, Gulhane Military Medicine Academy. d Assistant Professor, Gulhane Military Medicine Academy.
a b

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In some patients, the pattern of missing teeth may require the use of an FPD with a pier abutment. Restoration of 2 missing teeth and an intermediate pier abutment with a rigid FPD is not an ideal treatment.1-3 When an occlusal load is applied to the retainer on the abutment tooth at 1 end of an FPD with a pier abutment, the pier abutment may act as a fulcrum (Fig. 1).4,5 Thus, tensile forces may then be generated between the retainer and abutment at the other end of the restoration.5 Anterior or posterior abutments may experience extrusive forces during fulcrum action, and resultant tensile force at the retainerto-abutment interface5 may result in potential loss of retention for these restorations.4 It has been reported that rigid FPDs with pier abutments are associated with higher debonding rates than short-span prostheses.6,7 Thus, these restorations may result in marginal leakage and caries.4 Nonrigid connectors are suggested as a solution to these difficulties.4,6 A 50- to 100-g force may cause extrusion of abutments, depending on the location of the tooth in the dental arch.6,8 The reaction of the periodontium to extrusive forces on the teeth associated with FPDs with pier abutments is not clearly understood. These problems may be compensated for by converting an FPD with a rigid pier abutment into one with a nonrigid connector.4,6,9 Lin et al10 reported that a nonrigid connector has the ability to separate the splinted units. Thus, the use of a nonrigid connector has been suggested and is commonly used with FPDs.11-16 Direct experimental measurement of stress distribution at these locations is difficult. However, the FEM is a well accepted, theoretical method for calculating stress distribution within complex structures which allows investigators to evaluate the influence of model parameter variation once the model has been correctly defined.17,18 The FEM has been shown to be a useful tool when investigating complex systems that are difficult to

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1 Schematic illustration of pier abutment acting as fulcrum (blue represents anterior loading, and red represents posterior loading situations). standardize during in vitro and in vivo investigations.17 Also, the FEM results do not vary by repetition of the analysis and are restricted by the number of nodules and elements used in the model and the elastic constants attributed to the elements.17 Thus, in the present study, FEM was used to locate the ideal placement of a nonrigid connector for a pier abutment FPD by evaluating different placement variations. The choice of a 2-dimensional (2-D) or 3-dimensional (3-D) FEM is important.19 Even though the preparation of a 3-D model is more time consuming and costly, recent developments in computer technology have yielded more reliable results.19 It is possible to acquire more accurate results as the similarity of FEM models to vital structures increases. However, FEM has limitations related to assumptions that must sometimes be used while modeling. Since it is more comprehensive than the photoelastic technique,20 3-D FEM analysis was selected as the evaluation method in this investigation. The FEM provides mechanical responses and alters parameters in a more controllable manner, driving its common use as an analytical tool in dental biomechanical studies.10,18,20-24 The purpose of this study was to investigate and compare, by means of FEM stress analysis, the functional stresses generated under various occlusal forces with rigid and nonrigid designs for 5-unit FPDs with pier abutments. The null hypothesis was that the use of nonrigid connectors for FPDs with pier abutments would not affect the stress distribution.

MATERIAL AND METHODS

This study was conducted using a 3-D FEM and software (SAP2000; Computers & Structures, Inc, Berkley, Calif ). A 3-D cross-sectional FEM model was fabricated to represent a missing mandibular first premolar and first molar to perform the computer simulation. The model consisted of a 5-unit metal ceramic FPD, with the canine, second premolar, and second molar as abutment teeth supported by simulated periodontal ligament (PDL) and alveolar bone (cortical and trabecular) structures. The geometry used for the tooth model was previously described by Wheeler.25 On the basis of the rootform geometry of teeth, a simplified 0.25-mm PDL and a cortical shell (1.5 mm) were developed (Fig. 2), according to published values.26 To simulate the sliding function of a nonrigid connector, surfaces between the patrix and matrix of the nonrigid connectors were assigned as free (nonbonded) touching faces. Five FPDs were simulated, 1 with a rigid design and 4 with nonrigid designs, using varying locations and orientations for the nonrigid connectors. The matrix attachment was located within the abutment tooth for all scenarios.

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Design types are summarized in Table I. A 50-N static vertical occlusal load was applied on each cusp to calculate the stress distributions.17 Three different loading methods were used: loading of all teeth to simulate maximum centric occlusion contacts, loading of the canine to simulate a single anterior contact, and loading of the second molar to simulate a single posterior contact. Each mathematical model included 12,000 nodes and 9545 (8-node solid brick) elements. The nodes at the surfaces of the alveolar bone in the FEM models were fixed in all directions as the boundary condition. Materials used in this study were assumed to be homogenous and isotropic. Elastic properties of materials (Youngs modulus (E) and Poissons ratio ()) are determined from the literature and presented in Table II. Results were determined by considering von Mises criteria.27-32 Calculated numeric data were transformed into color graphics to better visualize the mechanical phenomena in the models.

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2 Illustration of materials modeled in FEM model.

Table I. Design configurations of 5-unit FPDs evaluated

Design Type
R MPosterior DPier MPier DAnterior

Rigid/Nonrigid
Rigid Nonrigid Nonrigid Nonrigid Nonrigid

Location of Nonrigid Connector

Not applicable Mesial to posterior terminal abutment Distal to pier abutment Mesial to pier abutment Distal to anterior terminal abutment

Table II. Mechanical properties of materials17

Material
Feldspathic porcelain NiCr alloy Dentin Pulp tissue Periodontal ligament Cortical bone Spongy bone

Elastic Modulus (E)(GPa)

82.8 206 18 0.003 0.069 13.7 1.37

Poissons Ratio ()
0.35 0.33 0.33 0.45 0.45 0.3 0.3

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RESULTS
The analysis of the von Mises stress values revealed that areas of maximum stress concentration were located at the loading areas for all models (2 MPa). Also, for all models, the highest stress values were located at connectors and cervical regions of abutment teeth, especially at the pier abutment. The stress concentration areas were found at root surfaces and apical tooth locations as well. For the rigid model, when the mesial terminal abutment was loaded, stresses were evident at the cusp tip (2 MPa) and at the root surface (0.46 MPa) of the loaded abutment, and at the mesial region of the pier abutment (0.46 MPa). A relatively low stress concentration was observed at the distal terminal abutment (Fig. 3). When the distal terminal abutment was loaded, stresses were detected the cusp tip (2 MPa) and at the root surface (1.08 MPa) of the loaded abutment, and at the distal region of the pier abutment (0.31 MPa). A relatively low stress concentration was detected at the mesial terminal abutment (Fig. 3). When all teeth were loaded, maximum stress concentration was observed at the cusp tips, connectors, and cervical regions of abutments (2 MPa). Also, other stress concentration areas (1.54 MPa) were observed at the root surfaces of the pier and distal terminal abutment (Fig. 3). Maximum principal stresses in the pier abutment were 0.77 MPa at anterior loading, 1.38 MPa at posterior loading, and 2 MPa when all teeth were loaded. In the design consisting of a nonrigid connector at the mesial region of the posterior terminal abutment (MPosterior), the stress distributions at the anterior loading position were similar to that of the rigid model, but for posterior loading, stresses were concentrated around the distal terminal abutment (1.08 MPa) (Fig. 4). When all teeth of the MPosterior model were loaded, stress concentrations were similar to those of the rigid model, but stress concentration at the distal root surface of the pier abutment (2 MPa) was higher and extended over a larger area than in the rigid model. Also, a higher stress concentration (2 MPa) was observed at the distal connector of the pier abutment (Fig. 4). Maximum principal stresses in the pier abutment were 0.46 MPa at anterior loading, 1.23 MPa at pos-

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terior loading, and 2 MPa when all teeth were loaded. The nonrigid connector at the distal region of the pier abutment (DPier) showed no considerable stress concentrations at the distal abutment with anterior loading (Fig. 5). The same situation occurred at the mesial terminal abutment when the distal terminal abutment was loaded (Fig. 5). The stress concentration levels were lowest at the pier abutment (0.15 MPa) in both situations, relative to other design types (Fig. 5). When all of the teeth were loaded, the maximum stress concentration (2 MPa) at the pier abutment was lower than other design types, but relatively high stress concentrations were observed at the mesial root surface of the distal terminal abutment (2 MPa) (Fig. 5). Maximum principal stresses in the pier abutment were 0.62 MPa at the anterior load point, 0.31 MPa at the posterior load point, and 2 MPa when all teeth were loaded. When the anterior terminal abutment was loaded, the nonrigid connector at the mesial region of the pier abutment (MPier) showed low stress concentration at the pier abutment (Fig. 6), similar to DPier. However,

3 von Mises stress values and distributions of rigid (R) (anterior loading (top right), posterior loading (top left), all teeth loaded (bottom)). Pink to blue colors represent stress values from lower to higher, respectively.

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4 von Mises stress values and distributions of MPosterior (anterior loading (top right), posterior loading (top left), all teeth loaded (bottom)). Pink to blue colors represent stress values from lower to higher, respectively.

5 von Mises stress values and distributions of DPier (anterior loading (top right), posterior loading (top left), all teeth loaded (bottom)). Pink to blue colors represent stress values from lower to higher, respectively. when the distal terminal abutment was loaded, there were lower stress concentrations at the pier abutment (0.46 MPa), and stress distributions at the posterior terminal abutment were similar to those of the rigid model (Fig. 6). When all the teeth were loaded, stress concentrations were observed at the cusp tips, connectors, cervical regions of abutments (2 MPa), and root surfaces (1.38 MPa) for all 3 abutments (Fig. 6). Maximum principal stresses in the pier abutment were 0.15 MPa for anterior loading, 1.23 MPa for posterior loading, and 2 MPa when all teeth were loaded. For the nonrigid connector at the distal region of the anterior terminal abutment design (DAnterior), when the terminal abutments were loaded, stress distributions were similar to those of the rigid model (Fig. 7). When all teeth were loaded, stress concentrations were similar to those of the rigid model. Stress concentration at the root surface of the pier abutment was similar (1.54 MPa), but

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6 von Mises stress values and distributions of MPier (anterior loading (top right), posterior loading (top left), all teeth loaded (bottom)). Pink to blue colors represent stress values from lower to higher, respectively.

7 von Mises stress values and distributions of DAnterior (anterior loading (top right), posterior loading (top left), all teeth loaded (bottom)). Pink to blue colors represent stress values from lower to higher, respectively. the value of 1.54 MPa was observed in a larger area than in the rigid model. Also, stress concentrations observed at the coronal aspect and the mesial and distal cervical regions of the pier abutment were high (2 MPa) (Fig. 7). Maximum principal stresses in the pier abutment were 0.46 MPa for anterior loading, 1.23 MPa for posterior loading, and 2 MPa when all teeth were loaded. distribution. It was observed that the rigid and nonrigid connector designs have effects on stress distributions in 5-unit FPDs with pier abutments. The FEM results are presented in terms of the von Mises stress values. The von Mises stresses depend on the entire stress field and are used as indicators of the possibility of damage occur-

DISCUSSION
The results support rejection of the null hypothesis: that the use of nonrigid connectors for FPDs with pier abutments would not affect the stress

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rence.32 Since the connectors represent the greatest stress concentration areas with FPDs, the placement of nonrigid connectors in these regions is recommended.15,16 Thus, nonrigid connectors were simulated in these regions in the current study. Moulding et al16 performed a photoelastic stress analysis of supporting alveolar bone as modified by nonrigid connectors. The authors reported that the stress fields change depending on the location of nonrigid connectors. The findings of the current study are in agreement with Moulding et al,16 as the stress fields were different at various locations of nonrigid connectors. Also, the authors stated that the rigid FPD distributes stresses vertically and evenly, and the nonrigid connectors located at the distal of canine and at the mesial of molar designs distribute stresses evenly; in fact, as well as the rigid FPD. In agreement with their findings, the results of the current study demonstrated that the stresses were distributed evenly with the rigid FPD design when all teeth were loaded. The stress distributions of nonrigid connectors located at the distal of the canine and at the mesial of the molar were similar to the rigid design when all teeth were loaded. It has also been reported that rigid and nonrigid connectors exhibit differences in stress distributions and concentrations within the supporting bone structure.4,9,16 The stress distributions in bone structure in the current study concur with those reported in previous studies.4,9,16 When a rigidly designed FPD with a pier abutment acts as a lever, high stress concentrations may occur at pier abutments, and excessive displacements may be observed at terminal abutments, resulting in damage to the abutment teeth. Thus, nonrigid connectors can be used to eliminate the fulcrum action of a pier abutment.6 The ideal placement of a nonrigid connector is reported to be in the distal region of the pier abutment.4,9 A comparison of stress distributions for different design types revealed that high stress values were located at the connectors and cervical regions of abutment teeth, especially at the pier abutment. Root surfaces and apical aspects were other stress concentration areas. However, with the use of a nonrigid connector, stress distribution patterns were reduced. Especially with the use of a nonrigid connector at the distal region of the pier abutment, the area of maximum concentration for the pier abutment was reduced. With this design type, there were no stress concentrations at the anterior abutment with posterior loading, and vice versa. This may be an indication of the nonrigid designs influence on prevention of the lever effect with a 5-unit prosthesis. The results of this study showed minimum stress values at the nonrigid connector with terminal loading conditions, and this result is in accordance with previous studies.4,9 Botelho and Dyson6 evaluated the longevity of long-span resin-bonded FPDs with 4 or more units with a modified nonrigid connector and increased extension of the retainer framework around the abutment. The authors found that long-span resin-bonded FPDs incorporating nonrigid connectors allow independent movement between the retainers, and, combined with increased framework extension, they appear successful in the short term. However, excessive stress concentrations occur at the anterior terminal abutment due to placement of a nonrigid connector at the mesial region of the pier abutment or distal region of the anterior abutment. Since the molar tooth has a larger periodontal membrane area than the canine tooth,5 as reported previously,16 this may be an advantage for the molar tooth. Thus, it is less desirable to have stress on the anterior abutment than the posterior abutment. The present study showed that with these nonrigid connector placements, stress concentrations were observed at the canine tooth. In the present study, the FEM technique was used. Several assumptions were made for the model used in this study regarding simulated structures. The structures in the model were all assumed to be homogenous, isotropic, and to possess linear elasticity. The properties of the materials modeled in this study, however, particularly the living tissues, are different. Also, it is important to note that the stress distribution patterns may have been different depending on the materials and properties assigned to each layer of the model and the model used in the experiments. Thus, the inherent limitations in this study should be considered. The value of 50 N was selected as the occlusal force. Since the same standard value was simulated in each model, it is not necessary for this force to match in vivo conditions exactly. Also, the conditions were compared qualitatively with each other in the current study. The results pertain only to the specific loads applied to the simulated restoration in the anterior region, posterior region, and all teeth. Thus, as with many in vitro studies, it is difficult to extrapolate the results of this study directly to the clinical situation. Further studies may be performed with additional loading positions, such as at the middle of the spans and adjacent to the connectors. Since location of the matrix of a nonrigid connector on an abutment tooth and the location of the patrix in the pontic is the most commonly used form,4 these locations were simulated in the current study. Future studies might evaluate other types of nonrigid connector designs for their effects on stress distribution.

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CONCLUSIONS
Within the limitations of this study, the following conclusions were drawn: 1. The stress distributions and values of an FPD and a pier abutment are affected by the presence and location of a nonrigid connector. 2. The area of minimum stress concentration occurs in pier abut-

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ments when a nonrigid connector is located at the distal region of the pier abutment for a 5-unit FPD (mandibular canine, second premolar, and second molar as abutments) with a pier abutment.
various occlusal forces with rigid/non-rigid connections. J Biomech 2006;39:453-63. 11.Sheets CG, Earthman JC. Tooth intrusion in implant-assisted prostheses. J Prosthet Dent 1997;77:39-45. 12.Rangert BR, Sullivan RM, Jemt TM. Load factor control for implants in the posterior partially edentulous segment. Int J Oral Maxillofac Implants 1997;12:360-70. 13.Nishimura RD, Ochiai KT, Caputo AA, Jeong CM. Photoelastic stress analysis of load transfer to implants and natural teeth comparing rigid and semirigid connectors. J Prosthet Dent 1999;81:696-703. 14.Becker CM, Kaiser DA, Jones JD. Guidelines for splinting implants. J Prosthet Dent 2000;84:210-4. 15.el-Ebrashi MK, Craig RG, Peyton FA. Experimental stress analysis of dental restorations. VII. Structural design and stress analysis of fixed partial dentures. J Prosthet Dent 1970;23:177-86. 16.Moulding MB, Holland GA, Sulik WD. Photoelastic stress analysis of supporting alveolar bone as modified by nonrigid connectors. J Prosthet Dent 1988;59:263-74. 17.Eraslan O, Sevimay M, Usumez A, and Eskitascioglu G. Effects of cantilever design and material on stress distribution in fixed partial denturesa finite element analysis. J Oral Rehabil 2005;32:273-8. 18.Lanza A, Aversa R, Rengo S, Apicella D, Apicella A. 3D FEA of cemented steel, glass and carbon posts in a maxillary incisor. Dent Mater 2005;21:709-15. 19.Ismail YH, Pahountis LN, Fleming JF. Comparison of two-dimensional and three-dimensional finite element analysis of a blade implant. Int J Oral Implantol 1987;4:25-61. 20.Darbar UR, Huggett R, Harrison A. Stress analysis technique in complete dentures. J Dent 1994;22:259-64. 21.Ko CC, Chu CS, Chung KH, Lee MC. Effect of posts on dentin stress distribution in pulpless teeth. J Prosthet Dent 1992;67:421-7. 22.Versluis A, Tantbirojn D, Douglas WH. Why do shear bond tests pull out dentin? J Dent Res 1997;6:1298-307. 23.Chen J, Xu L. A finite element analysis of

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the human temporomandibular joint. J Biomech Eng 1994;116:401-7. 24.Savion I, Saucier CL, Rues S, Sadan A, Blatz M. The pier abutment: a review of literature and suggested mathematical model. Quintessence Int 2006;37:345-52. 25.Ash MM. Wheelers atlas of tooth form. 5th ed. Philadelphia: Elsevier Health Sciences; 1984. p. 68. 26.Tada S, Stegaroiu R, Kitamura E, Miyakawa O, Kusakari H. Influence of implant design and bone quality on stress/strain distribution in bone around implants: a 3- dimensional finite element analysis. Int J Oral Maxillofac Implants 2003;18:357-68. 27.Beer FP, DeWolf JT, Johnston ER. Mechanics of materials. 4th ed. Singapore: McGraw-Hill Int; 2005. p. 360-78. 28.Ugural AC, Fenster SK. Advanced strength and applied elasticity. 4th ed. New York: Prentice-Hall; 2003. p. 155-7. 29.Akca K, Iplikcioglu H. Finite element stress analysis of the influence of staggered versus straight placement of dental implants. Int J Oral Maxillofac Implants 2001;16:722-30. 30.Yang HS, Lang LA, Molina A, Felton DA. The effects of dowel design and load direction on dowel-and-core restorations. J Prosthet Dent 2001;85:558-67. 31.Timoshenko S, Young DH. Elements of strength of materials. 5th ed. Florence: Wadsworth; 1968. p. 377. 32.Pegoretti A, Fambri L, Zappini G, Bianchetti M. Finite element analysis of a glass fibre reinforced composite endodontic post. Biomaterials 2002;23:2667-82. Corresponding author: Dr Oguz Eraslan University of Selcuk, Faculty of Dentistry Department of Prosthodontics 42079 Kampus Konya TURKEY Fax: 90 332 2410062 E-mail: oguzeraslan@selcuk.edu.tr Copyright 2008 by the Editorial Council for The Journal of Prosthetic Dentistry.

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