Evaluating the effect of functionally graded materials on bone remodeling around dental implants

A missing tooth can lead to problems such as eating, speaking, and sometimes serious issues with self-confidence [1]. Dental implants are currently the only restorative technique that preserves and stimulates natural bone, but their success rate is influenced by various factors, such as implant geometry, bone quality, stability factors, and implant insertion region [2]. While recent advancements in the implant industry have improved the success rate of dental implants, achieving secondary stability remains a significant concern [3]. Bone remodeling is one of the key factors in achieving this goal.

Throughout an individual's lifetime, bone formation and resorption occur continuously and are coordinated to maintain essential bone mass and optimal internal structure through remodeling [4]. Wolff's Law states that bone responds to external forces and adapts its structure through a remodeling process that is proportional to the magnitude and direction of the forces applied [5]. When a manufactured component, such as a dental implant, is inserted into the body, it can disrupt the regular distribution of stimuli due to a phenomenon called "stress shielding". This occurs because the implanted component can bear more load and force than the surrounding tissue would typically experience, leading to changes in bone density and, in some cases, implant failure [6], [7].

According to Thomson et al. [8], the material properties of implants can strongly impact periprosthetic bone remodeling. Therefore, one key strategy to enhance the performance of prostheses is to re-engineer the material properties of implants. Although these materials are excellent for medical applications due to the high hardness of ceramics and the acceptable ductility of metals, choosing the right materials for the body environment can be challenging due to the brittleness of ceramics and the low wear resistance of metals [9]. One promising approach to improving implant function is through the use of functionally graded materials (FGMs), which exhibit gradually changing properties. FGMs have been used to create more effective implants with improved biocompatibility, reduced stress shielding, and suitable conditions for bone in-growth and osseointegration [10], [11], [12].

Recent strides in materials science have given rise to innovative biomaterials, particularly radial Functionally Graded Material (FGM) implants, showcasing improved biomechanics and reduced peri-implant stress [13], [14], [15]. However, aligning optimal implant design, considering both stress distribution and structural rigidity, with the nuanced demands of bone remodeling remains an ongoing research challenge [16]. Ti-Hap FGM dental implants offer a unique blend of customizable mechanical strength, featuring robustness at the Ti-rich end and heightened biocompatibility at the Hap-rich end [12], [16], [17]. This design promotes bone-like apatite formation, releases calcium and phosphorous ions, ensuring biocompatibility, and mitigates corrosion risk [18]. Overcoming Hap's brittleness, the incorporation of Ti enhances wear resistance in Ti-Hap FGM dental implants.

Achieving successful dental implant outcomes requires consideration of the correlation between implant geometry and stress distribution in the bone-implant construct. Recent studies have indicated that implant diameter has a greater impact on stress distribution than implant length, underscoring the importance of carefully evaluating implant dimensions during placement [19], [20]. Implant geometry and marginal bone loss are other important factors to consider for optimal clinical outcomes [21], [22]. Despite contradictory findings in the literature regarding which parameter is more effective in achieving optimal stress distribution [23], [24], [25], [26], both implant diameter and length should be considered carefully by clinicians during implant planning and placement to achieve the best possible clinical outcome.

Despite significant progress in the field of dental implants with numerous studies on implant geometry and materials, only a few researchers have considered the bone remodeling process and its long-term impact on final bone quality. Furthermore, limited studies have utilized detailed anatomical 3D models to investigate the bone remodeling process, which fails to account for the effect of the mandible bone's complex geometry. New combinations of synthetic biomaterials, including porous [27] and solid composites [7], are being developed for use in dental implants, whereas others are constituted as solid composite structural forms. However, polymers and composites have several drawbacks, such as sensitivity to sterilization and handling, electrostatic surface properties that attract dust and particulates in oral environments, and poor durability [28].

This study assesses the ultimate configuration of peri-implant tissues in a 3D Titanium Hydroxyapatite (Ti-HAP) dental implant model to fill gaps in current research on dental implants. Simulations of the bone remodeling process were used, and different dimensions of the implant's diameter and length, as well as various FGM compounds, were compared. Additionally, a precise anatomy of a mandibular slice was created using CT scan images. The potential of Ti-HAP FGM in the production of dental implants and its effect on bone remodeling were explored. The study's findings will contribute to the optimization of dental implants, reduce implant failure rates, and promote better patient outcomes.

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