Effect of Bone Quality, Implant Length, and Loading Timing on Stress Transmission in the Posterior Mandible: A Finite Element Analysis.

This study aimed to evaluate the biomechanical effects of implant length, mandibular morphology, graft application, loading timing, and force direction on peri-implant stress distribution using finite element analysis (FEA). Five mandibular models representing normal, atrophic, and graft-augmented conditions were constructed. Each model was analyzed with 6 mm and 12 mm Straumann Standard implants under two loading types, vertical (200 N) and oblique (100 N at 30°), across three loading protocols (immediate, early, and delayed). Stress analysis was conducted using von Mises and principal stress criteria, focusing on cortical and trabecular bone, the implant-abutment complex, and the mandibular canal. Under vertical loading, increasing the implant length from 6 mm to 12 mm reduced the maximum tensile stresses in trabecular bone from 0.930 MPa to 0.475 MPa (an approximate 49% decrease). However, oblique loading caused a substantial increase in stresses in all regions, with trabecular compressive stress reaching up to -19.102 MPa and cortical tensile stress up to 179.798 MPa in the atrophic mandible. Graft application significantly reduced peri-implant stresses; for example, maximum compressive stress in the cortical bone decreased from -227.051 MPa in the atrophic model to -13.395 MPa in the grafted model under similar loading conditions. Although the graft donor site was not explicitly modeled, the graft material (Bio-Oss) was anatomically positioned in the posterior mandible to simulate buccolingual augmentation and its biomechanical effects. Stress concentrations around the mandibular canal remained below the 6 MPa threshold for neurovascular injury in all scenarios, indicating a biomechanically safe outcome. These findings indicate that oblique loading and reduced bone volume may compromise implant survival, whereas graft application plays a critical role in mitigating stress levels and enhancing biomechanical stability. The study also emphasizes the importance of considering force direction and bone quality in clinical planning, and highlights the novelty of combining graft simulation with FEA to assess its protective role beyond implant length alone.