Three-dimensional finite element analysis of implant stability in the atrophic posterior maxilla: a mathematical study of the sinus floor augmentation.

Sinus lifting is performed with a variety of materials and techniques without a precise knowledge of the quantity of augmentation. This study based on three-dimensional finite element analysis was designed to show which surgical procedure and which amount of peri-implant packing yields the best bony support for dental implants. Eight 3D-FE models were used. Four modeled standard situations simulated quantitatively different packing situations produced by differences in surgical approach: i. no packing; ii. thin 1 mm bony sheath; iii. oblique subcomplete packing; iv. complete bony peri-implant packing up to the implant end. A fifth model compared a standard implant with a length of 13.5 mm and a diameter of 3.75 mm with a 7-mm-long and 5-mm-thick implant. In three additional models the stress response of the bone-implant system was evaluated in the absence of a cortical layer, thus simulating an extreme degree of maxillary atrophy. In all models the modeled implants were loaded at their points of emergence with an assumed force of 100 N. The vector of the loading force was inclined 30 degrees posteriorly relative to the implant axis and 30 degrees away from the sagittal plane. The bone-implant interface was assumed to be perfect simulating full osseointegration. The final evaluation of the FE models showed complete peri-implant packing to reduce displacements of the implant tip by 32% vs. no sheathing/packing. Van Mises' equivalent stresses were used to assess the stresses in both human bone and titanium alloy implants. The highest stress levels in bone were predicted for the case without sufficient implant sheathing. In the models with adequate bony implant support, intrabony stresses were generally reduced by up to - 40%. The structural stiffness of the bone-implant system increased with the extent of sinus floor elevation. The results indicate that more extensive peri-implant packing reduces implant displacement, intrabony stresses and stresses at the bone-implant interface.