Biomechanical characteristics of maxillary anterior incisor, conventional immediate implantation and socket shield technique - A finite element analysis and case report

Background: To prevent the absorption and collapse of the labial bone plate of the anterior teeth, immediate implantation and socket shield technique have been increasingly applied to anterior dental aesthetic implant restoration. Objective: To provide a biomechanical basis for implant restoration of maxillary anterior teeth, finite element analysis was used to investigate the stress peak and distribution in different anatomical sites of natural teeth, conventional immediate implantation and socket shield technique. Methods: Three maxillary finite element models were established, including a maxillary incisor as a natural tooth, a conventional immediate implantation and a socket shield technique. A mechanical load of 100 N was applied to simulate and analyze the biomechanical behavior of the root, periodontal ligament (PDL), implant and surrounding bone interface. Results: The stress distribution of the natural tooth was relatively uniform under load. The maximum von Mises stress of the root, periodontal ligament, cortical bone and cancellous bone were 20.14 MPa, 2.473 MPa, 19.48 MPa and 5.068 MPa, respectively. When the conventional immediate implantation was loaded, the stress was mainly concentrated around the neck of implant. Maximum stress on the surface of the implant was 102 MPa, the cortical bone was 16.13 MPa, and the cancellous bone was 18.29 MPa. When the implantation with socket shield technique was loaded, the stress distribution of the implant was similar to that of immediate implantation. Maximum stress on the surface of the implant was 100.5 MPa, the cortical bone was 23.11 MPa, the cancellous bone was 21.66 MPa, the remaining tooth fragment was 29.42 MPa and the periodontal ligament of the tooth fragment was 1.131 MPa. Conclusions: 1. Under static loading, both socket shield technology and conventional immediate implantation can support the esthetic restoration of anterior teeth biomechanically. 2.Under short-term follow-up, both immediate implant and socket shield technology achieved satisfactory clinical results, including bone healing and patient satisfaction. 3.The stress distribution is mainly located on the buccal bone surface of the implant and is associated with resorption of the buccal bone plate after implant replacement in both socket shield technology and conventional immediate implantation. 4.The presence of retained root fragment had an impact on the bone graft gap. In immediate implantation, the peak stress was located in the cortical bone near the implant position, while in socket shield technology, the peak stress was at the neck of the cortical bone corresponding to the retained root fragment.