The insertion torque of a dental implant is an important indicator for the primary stability of dental implants. Thus, the preoperative prediction for the insertion torque is crucial to improve the success rate of implantation surgery. In this present research, an alternative method for prediction of implant torque was proposed. First, the mechanical model for the insertion torque was established based on an oblique cutting process. In the proposed mechanical model, three factors, including bone quality, implant geometry and surgical methods were considered in terms of bone-quality coefficients, chip load and insertion speeds, respectively. Then, the defined bone-quality coefficients for cancellous bone with the computed tomography (CT) value of 235–245, 345–355 and 415–425 Hu were obtained by a series of insertion experiments of IS and ITI implants. Finally, the insertion experiments of DIO implants were carried out to verify the accuracy of developed model. The predicted insertion torques calculated by the mechanical model were compared with those acquired by insertion experiments, with good agreement, the relative error being less than 15%. This method allows the insertion torque for different implant types to be quickly established and enhances prediction accuracy by considering the effects of implants’ geometries and surgical methods.
1 Introduction
Implant dentures have been one of the most popular options for teeth loss in last decade [1]. After the implant socket is prepared by a series of processes such as drilling, reaming and tapping, the implant is inserted in alveolar bone with a certain torque, which called the insertion torque. Most clinical data shows that 30–70 N·cm is a reasonable range of insertion torque to achieve satisfactory initial implant stability. This means that if the insertion torque for the implant is in this range, it would ideally be considered that the surgery would be successful [2‐4], otherwise, the surgery would fail. As the insertion torque can only be known after the whole implant is inserted, if the insertion torque is not good (lower than 30 N·cm or higher than 70 N·cm), the patient has to endure a second surgery. However, if the insertion torque could be predicted before the surgery, it would allow the dentist to make or adjust the surgery plan and improve the surgery success rate. So, this research focuses on the preoperative prediction of the insertion torque. Actually, the reasonable range of insertion torque is different for each patient, depending on their age, gender and height [5, 6], and also implant shape and diameter [7, 8], loading condition [9], etc. However, it is supposed here that the 30–70 N·cm is reasonable for any condition.
To predict implant insertion torque, three factors, implant geometries [10], surgical methods [11, 12] and bone quality, have been considered. It has been shown that the larger insertion torque can be obtained by a conical [13], large-diameter implant [14] or a small-diameter implant socket [15, 16]. Bone quality, which is primarily influenced by bone density, is a key focus for dentists in-clinic, and has been shown to be positively correlated with insertion torque [17]. Computed tomography (CT) is normally used to quantify bone density in-clinic and several empirical fits have been established for the linear relationship between CT value and insertion torque, which were further used to predict the insertion torque [18‐21]. The accuracy of these empirical fits is largely high, (greater than 80%), however, these formulas are only suitable for just one combination of implant and method of surgery. In order to use empirical formulas to predict the insertion torque, formulas for every combination of implants and surgery would have to be established, which would be time-consuming and expensive.
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In this research, an alternative method to predict the insertion torque is provided by establishing a mechanical model based on oblique cutting theory, although it has been widely accepted in engineering, has not previously been used in calculating insertion torque for dental implants. In the proposed model, using DIO implants as an example, the effects of implant geometry and surgical methods were captured by chip load and insertion speeds, respectively, meanwhile the effect of bone quality was considered by the defined coefficients, termed bone-quality coefficients. Then, the bone-quality coefficients for the bone quality with CT value of 235–245, 345–355 and 415–425 Hu were obtained by a series of insertion experiments using the IS and ITI implants. With the obtained coefficients, a relationship between insertion torque and bone quality was obtained. Then, the DIO implants were used to verify the accuracy of the developed model. The results show that the model has high accuracy with relative error less than 15%.
2 Mechanical Model Based on Oblique Cutting Theory
The insertion process for dental implants involves two forming methods, i.e., the thread-cutting process [22] for implants with cutting edges and the thread-forming process for implants without cutting edges [23]. In this section, the implant typed DIO SFR5010 (DIO Innovation Health Care, Busan City, Korea) with 4 cutting edges in the apical part and continuous threads in the tail part was selected to establish the mechanical model for insertion torque.
2.1 Forming Process of Matching Threads
Figure 1 describes the geometry of DIO SFR5010 and its insertion process, where Figure 1(a) is the initial position of implant while Figure 1(b) is the position after one thread was inserted. The threads in the bone are initially formed by successive passes of the cutting edges in the apical part of the implant, in a similar operation to thread-cutting using a tap. This process is called the thread-cutting process, and the bone debris generate in this process. The threads in the tail part of the implant, without cutting edges, are subsequently inserted [24], in what is called the thread-forming process without bone debris generation.
×
To detail the shape of the matching threads, DIO SFR5010 was cut into 12 thin slices considering only one thread in each. In the apical part, each slice was further separated into 4 cutting elements by 4 cutting edges. The whole process was separated into 12 steps, with one thread inserted into the implant socket per step. The shape of the matching threads in each step was defined by the cutting element passed last. A global coordinate system {C:OXYZ} was attached to the implant. Its origin point O was the starting point of the first threads, and its Z-axis was set along the axis of rotation. The cutting element coordinate system {c:oixiyizi} was given to each cutting element. Its x-axis was set parallel to the helical path, where i indicates the ith thread.
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The helical path of the matching thread is the same as that of the implant threads, and can be expressed as follows:
x, y, z are the point coordinates of the helical path; θ is the angular position of the helical path; b, hd, P and β are the initial radius, tooth height, pitch and taper angle of DIO SFR5010, respectively. Particularly, in the tail part, β = 0.
The radius ri of the matching thread can be given by the radial distance from the Z-axis to the outer geometry of the ith thread as:
where, ξ and λ are the thread lead angle and the flute helix angle, respectively.
2.2 Force–chip Load Relationship
Three assumptions were made as follows: ① each cutting element sustains normal and friction forces, and all forces are applied on the centroid of the respective faces; ② the effects of elastic recovery for the prediction of insertion torque were ignored; ③ insertion torques generated by one thread remained constant throughout the whole insertion process.
According to these assumptions, the forces applied on all cutting elements can be composed of the normal force Fn and the friction force Ff as follows [25]:
$$F_{n} = K_{n} A,$$
(5)
$$F_{f} = K_{f} A,$$
(6)
A is chip load, which is equal to the unformed chip area and depends on the implant geometry; Kn and Kf are specific energies, which are related to the tool geometry and work conditions as follows [26]:
$$\ln K_{n} = a_{0} + a_{1} \ln h + a_{2} \ln V + a_{3} \ln h\ln V,$$
(7)
$$\ln K_{f} = b_{0} + b_{1} \ln h + b_{2} \ln V + b_{3} \ln h\ln V,$$
(8)
V is the insertion speed, h is the radial engagement of each cutting element, and a0–a3 and b0–b3 are the specific energy coefficients which depend on materials of the cutting tool (i.e., implant) and the workpiece (i.e., cancellous bone). As most most implants are composed of titanium or titanium-alloys, the a0–a3 and b0–b3 were only determined by bone quality and defined as bone-quality coefficients.
Considering the normal force Fn and the friction force Ff are different during thread-cutting and thread-forming processes, they are discussed in Sections 2.2.1 and 2.2.2, respectively.
2.2.1 Forces in Thread-cutting Process
In the thread-cutting process, as the cutting velocity and the chip flow directions are not perpendicular to the cutting edge, this can be considered an oblique cutting process [27, 28] as shown in Figure 2. The coordinate system {c:oxiyizi} is used to define the forces on each elements during thread-cutting process. Two planes, the normal and chip-flow plane, were introduced. The normal plane was defined by the xi-axis and zi-axis and the chip-flow plane was coincident with the rake surface of the cutting edges. In the normal plane, the normal force Fcni was defined perpendicular to the rake surface. In the chip-flow plane, the friction force Fcfi was defined collinear with the chip-flow orientation [29]. Meanwhile, the chip-flow angle i was defined equal to the inclination angle γ based on the Stabler’s rule.
×
According to Eqs. (5) and (6), Fcni and Fcfi can be expressed as follows:
$$F_{cni} = K_{cn} A_{ci} ,$$
(9)
$$F_{cfi} = K_{cf} A_{ci} ,$$
(10)
where, Aci are the chip load of the ith cutting element, and Kcn and Kcf are the specific energies in the thread-cutting process. According to Eqs. (7) and (8), these can be calculated as:
where, Nt is the number of cutting edges. For DIO SFR5010, Nt = 4.
By decomposing Fcni and Fcfi into the three axes of {c:oxiyizi}, three axial forces \(F_{{x_{i} }}\), \(F_{{y_{i} }}\) and \(F_{{z_{i} }}\) can be obtained as follows:
Then, the thrust force \(F_{{thr_{i} }}\) and tangential force \(F_{{tan_{i} }}\) of each cutting element and the total insertion torque M can be calculated from Eqs. (16)–(18), respectively.
Like the thread-cutting process, in the thread-forming process, the cutting velocity and the chip flow directions are not perpendicular either. Therefore, the model was also based on oblique cutting (forming).
However, in this process, as previously mentioned, there is no cutting process, the matching thread is formed by bone plastic deformation and flow. To define the forces during the thread-forming process, six faces named S1–S6 were introduced as shown in Figure 3. The highest portion of the implant edge, defined by S4–S6, was named as the lobe. This defines the final geometry of the matching thread. The regions before the lobe have a slope to provide relief, which was used to minimize the contact between the implant and the bone material. The normal forces Fni were defined proportional to the contact areas, and the friction forces Ffi were defined collinear with chip-flow orientation [30], in the same way as the thread-cutting process:
$$F_{fni} = K_{fn} A_{fi} ,$$
(19)
$$F_{ffi} = K_{ff} A_{fi} ,$$
(20)
where, Kfn and Kff are the specific energies during the thread-forming process. According to the Eqs. (7) and (8), they can be calculated using:
where, hi is the radial engagement of the ith thread and it was given by Eq. (3), α is the thread angle, η1 and η2 are the incident angle and the lobe-relief angle of threads, respectively, zi is the z coordinate of the point Q and it is given by:
Then, the thrust force \(F_{{thr_{i} }}\) and the tangential force \(F_{{tan_{i} }}\) of each cutting element and the total insertion torque M can be calculated by:
According to Eqs. (15)–(18) and (26)–(29), it could be observed that the insertion torque was related to the normal and the friction force, which were determined by ① bone-quality coefficients, ② insertion speed V, ③ radial engagement hi and ④ chip load A. These give a good explanation for the effects of the bone quality, surgical methods, and the implant geometry, respectively. When the implant and the surgical method were selected, hi, A and V can be determined. The only consideration is the bone-quality coefficients, which were given in Section 3.
3 Determination of Bone-quality Coefficient and Validation of Mechanical Model
To define the bone-quality coefficients, more than 80 bone blocks with the size of 25 × 25 × 40 mm3 were cut from the epiphysis areas of four bovine femurs with different age, weight and gender as shown in Figure 4. The mean CT value of bone material within 1 mm around the predicted implant socket for each bone block as shown in Table 1 were recorded by Planmeca ProMax® 3D Mid CT (Planmeca UK Limited, Coventry, UK. scanning time: 13.929 s, tube voltage: 90 kV tube current: 10 mA). According to recorded CT value, 36 bone blocks were selected and further classified into 3 groups with the CT value of 235–245, 345–355, and 415–425 HU, respectively.
Table 1
CT value of 3 group bone blocks
Group 1
CT (Hu)
Group 2
CT (Hu)
Group 3
CT (Hu)
A01
237.60
B01
354.86
C01
418.48
A02
241.54
B02
345.35
C02
419.58
A03
236.42
B03
352.68
C03
417.99
A04
237.08
B04
346.42
C04
422.54
A05
242.13
B05
348.57
C05
420.26
A06
239.56
B06
353.63
C06
421.41
A07
241.69
B07
349.21
C07
417.69
A08
235.69
B08
350.96
C08
423.93
A09
237.72
B09
354.12
C09
415.34
A10
240.34
B10
348.56
C10
419.47
A11
237.32
B11
350.12
C11
416.95
A12
241.80
B12
349.61
C12
424.01
Range
235–245
Range
345–355
Range
415–425
×
3.1 Insertion Experiments
Three groups of insertion experiments were conducted. The geometry parameters of these implants were shown as Table 2.
Table 2
Implant parameters
Implant
Appearance
Angle (°)
Size (mm)
IS BIS4510
β1=1.0
L=10
β2=17
D= ϕ4.5
α1=6
P=0.8
α2=30
hd=0.25
λ=90
w=0.08
φ=0
H=ϕ4.4
IS BIS5010
β1=1.7
L=10
β2=17
D= ϕ5
α1=6
P=0.8
α2=30
hd=0.25
λ=90
w=0.08
φ=0
H=ϕ4.9
ITI RN4210
β=0
L=10
α=30
D=ϕ4.8
η1=85
P=1.25
η2=10
H=ϕ4.2
ξ=4.74
w=0.1
ITI RN4810
β=0
L=10
α=30
D=ϕ4.8
η1=85
P=1.25
η2=10
H=ϕ4.2
ξ=4.74
w=0.1
DIO SFR5010
β1=0
L1=2.5
α1=8.5
D1=ϕ5.0
η1=85
P1=0.4
η2=10
H1=ϕ4.9
ξ=1.5
w1=0.05
β2=8.75
L2=6.5
α2=7
D2=ϕ5
α3=30
P2=0.8
λ=90
H2=ϕ4.2
φ=0
w2=0.12
In Table 2, β1, α1, L1, D1, P1, H1 are the parameters of apical part of implant DIO SFR5010 while β2, α2, α3, L2, D2, P2, H2 the tail part of implant DIO SFR5010.
IS implants (IS BIS4510 and IS BIS5010, Neobiotech Co.,Ltd., Seoul, Korea) with cutting edges were used to determine bone-quality coefficients a0–a3 and b0–b3 while ITI implants (ITI RN4510 and ITI RN5010, ITI International Team for Implantology, Basel, Switzerland) without cutting edges were used to determine bone-quality coefficients c0–c3 and d0–d3. DIO SFR5010 were used to verify the established model.
The insertion experiments involved the drilling processes of implant sockets and the insertion process of implants. They were conducted on the CNC machine (HAAS OM-2A, Haas Automation Inc., Oxnard, CA, USA). The equipment setting was shown in Figure 5. The parameters of drills and experiment setting were listed as Table 3. To minimize the coaxially error between the implants and corresponding predicted implant sockets, there was no interruption between the drilling and insertion processes. The high accuracy dynamometer (Kistler9119AA2, Kistler Instruments Ltd., London, UK, sampling rate: 1200 Hz) was used to capture the thrust forces and insertion torques during the insertion process of implants.
Table 3
Parameters of insertion experiments
Drills and Implants
types
Bone blocks
No.
Diameter
d (mm)
Insertion speed ω (r/min)
Feed rate
v (mm/min)
IS TSD22F
A01–A02; B01–B02; C01–C02
2.2
1200
10
IS TSD29F
A01–A02; B01–B02; C01–C02
2.9
1200
10
IS TSD34F
A01–A02; B01–B02; C01–C02
3.4
1200
10
IS TSD39F
A01–A02; B01–B02; C01–C02
3.9
1000
10
IS TSD44F
A01–A02; B01–B02; C01–C02
4.4
800
10
IS BIS4510
A01; B01; C01
4.5
20
16
IS BIS4510
A02; B02; C02
4.5
30
24
IS TSD22F
A03–A05; B03–B05; C03–C05
2.2
1200
10
IS TSD29F
A03–A05; B03–B05; C03–C05
2.9
1200
10
IS TSD34F
A03–A05; B03–B05; C03–C05
3.4
1200
10
IS TSD39F
A03–A05; B03–B05; C03–C05
3.9
1000
10
IS TSD44F
A03–A05; B03–B05; C03–C05
4.4
1000
10
IS TSD49F
A03–A05; B03–B05; C03–C05
4.9
800
10
IS BIS5010
A03; B03; C03
5.0
20
16
IS BIS5010
A04–A05; B04–B05; C04–C05
5.0
30
24
ITI 044.210
A06–A07; B06–B07; C06–C07
2.2
800
10
ITI 044.214
A06–A07; B06–B07; C06–C07
2.8
600
10
ITI 044.250
A06–A07; B06–B07; C06–C07
3.5
500
10
ITI RN4110
A06; B06; C06
4.1
12
15
ITI RN4110
A07; B07; C07
4.1
15
18.75
ITI 044.210
A08–A10; B08–B10; C08–C10
2.2
800
10
ITI 044.214
A08–A10; B08–B10; C08–C10
2.8
600
10
ITI 044.250
A08–A10; B08–B10; C08–C10
3.5
500
10
ITI 044.254
A08–A10; B08–B10; C08–C10
4.2
400
10
ITI RN4810
A08; B08; C08
4.8
12
15
ITI RN4810
A09–A10; B09–B10; C09–C10
4.8
15
18.75
DIO DHI 2010SM
A11–A12; B11–B12; C11–C12
2.0
1000
10
DIO SDS 2710M
A11–A12; B11–B12; C11–C12
3.5
1000
10
DIO DTS 4110M
A11–A12; B11–B12; C11–C12
4.0
1000
10
DIO DTS 4510M
A11–A12; B11–B12; C11–C12
4.4
1000
10
DIO DTI 5010SM
A11–A12; B11–B12; C11–C12
4.9
800
10
DIO SFR5010
A11–A12; B11–B12; C11–C12
5.0
15
12
×
3.2 Bone-quality Coefficients
The results of thrust forces \(F_{{thr_{i} }}\) and insertion torques of IS and ITI implants were presented as Figure 6.
×
The peak torque and thrust force were used to determine the bone-quality coefficients for thread-cutting and thread-forming processes. The obtained bone-quality coefficients were listed in Tables 4 and 5.
Table 4
Bone-quality coefficients for thread-cutting
Group
a0
a1
a2
a3
b0
b1
b2
b3
1
14.6
0.17
0.44
0.03
12.9
0.02
0.17
0.003
2
16.7
0.37
0.77
0.07
13.2
0.02
0.18
0
3
58.1
4.81
8.19
0.86
52.8
4.43
7.29
0.795
Table 5
Bone-quality coefficients for thread-forming
Group
c0
c1
c2
c3
d0
d1
d2
d3
1
22.4
0.06
0.16
0
21.2
0.06
0.15
0
2
27.3
0.57
0.82
0.07
26.1
0.57
0.82
0.07
3
60.4
3.87
6.86
0.68
59.2
3.87
6.86
0.68
It was observed that the bone-quality coefficients a0–a3, b0–b3, c0–c3 and d0–d3 were different in 3 group, which is the good explanation for the effects of bone quality.
Until now, we can get the general equations for dentists to predict insertion torque by substituting the bone-quality coefficients into the mathematical framework. Taking Group 1 as an example, Kcn, Kcf, Kfn and Kff were given by:
The predicted insertion torque of bone block A11, A12, B11, B12, C11, C12 were compared with that obtained by insertion experiments using DIO SFR5010. The torques of each thread during the insertion processes were listed in Figure 7 and Table 6. The insertion torque is the peak torque. As the bone blocks A11 and A12 are both in Group 1, thus, they share the same bone-quality in either thread-cutting or thread forming process, and there is only one predicted value to be compared, same as B11 and B12, C11 and C12.
Table 6
Comparison of averaged insertion torques from experiments and predictions
Thread number
Group 1
Group 2
Group 3
Measured
(N·cm)
Pred
(N·cm)
Measured
(N·cm)
Pred
(N·cm)
Measured
(N·cm)
Pred
(N·cm)
1
1.899
1.669
2.256
0.693
1.036
2.244
1.167
3.158
2.693
2
4.872
4.559
5.270
2.237
4.693
6.012
5.394
7.061
7.214
3
9.805
10.272
8.284
4.693
7.125
9.779
8.171
10.475
11.735
4
12.050
12.197
11.298
8.693
12.362
13.547
12.617
15.392
16.256
5
15.874
13.893
14.312
13.369
14.639
17.314
23.872
22.389
20.777
6
17.274
15.325
17.326
15.693
18.693
21.082
25.349
28.869
25.298
7
18.326
20.186
20.340
18.639
22.237
24.849
33.995
33.612
29.819
8
22.264
20.362
23.354
24.363
23.140
28.617
34.693
38.118
34.34
9
23.592
21.369
24.279
26.964
27.063
30.256
35.460
41.636
36.471
10
24.362
22.012
25.206
27.365
28.634
31.895
36.256
43.124
38.602
11
24.982
23.937
26.132
29.369
29.363
33.534
37.596
44.691
40.733
12
25.193
24.102
27.058
30.069
31.693
35.174
38.172
46.786
42.864
error
7.4%
12.3%
0
16.9%
10.9%
0
12.4%
8.4%
0
×
In Figure 7 and Table 6, the two series of measured values for Group 1–3 were obtained by insertion experiments by bone blocks A11, A12, B11, B12, C11, C12, respectively. As shown in Figure 7, the variations of material properties of bone blocks brought a significant fluctuation of the initial insertion torques obtained by experiments. But the trends and predicted peak insertion torques by mechanical models agreed well with that acquired by insertion experiments. The relative errors were calculated as follows.
The errors were mainly caused by ① the simplification in the modeling process; ② the deviation between the predicted implant sockets and the real implant sockets. As the surgery process for implant socket is fully conducted by dentist, the real implant sockets could not perfect as predicted one. There would be, for example, the deviation for position or the central axis even for a skilled dentist; ③ the heterogeneous of bone quality in CT scan area. As the material properties for bone material does not only depend on the bone density, but it also depends on the microstructure of the trabecular bone, the unit of the cancellous bone. As the microstructure of the trabecular bone is complex and different from point to point, there is high heterogeneous properties for bone material. In prediction model, the material properties of bone are decided by bone density, therefore, the effect of the heterogeneous cannot be predicted. We think, the error within 15% could be accepted in clinical prediction. In addition, considering the errors were contributed by three influence factors: bone quality, implant geometry and surgical methods, there is no doubt that the predicted model we established with the relatively high accuracy.
4 Conclusions
In this research, a mechanical model was established for the insertion torque of dental implant. The effect of bone quality, the surgical method and the implant geometry were explained by the model parameters: ① bone-quality coefficients, ② insertion speed, and ③ radial engagement hi, chip load A and implant diameter ri, respectively. The more specific conclusions can be drawn as follows:
(1)
The bone-quality coefficients were determined by bone CT value and different in implants with or without cutting edges. The reasonable explanation for this may be the bone quality depended not only on bone density, i.e., bone CT value, but also the microstructure of trabecular bone.
(2)
The error of this mechanical model result from the ① the simplification of modeling; ② the ignored effects of local anisotropy and heterogeneous of bone quality; ③ the surgical errors.
(3)
The established mechanical model can help dentists to make accurate assessment whether the implants and surgical methods are reasonable for individual. Comparing to the fitting formulas, this method can avoid plenty of experiments caused by changing implants and surgical method.
Acknowledgements
The authors sincerely thanks to Professor Feng Jiang of Huaqiao University for his kindness help and critical discussion during experiment preparation.
Competing interests
The authors declare no competing financial interests.
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