Purpose This study combines clinical investigation with finite element (FE) analysis to explore the effects of buccal bone thickness (BBT) on the morphological changes of buccal bone induced by the loaded implant. Methods One specific patient who had undergone an implant treatment in the anterior maxilla and experienced the buccal bone resorption on the implant was studied. Morphological changes of the bone were measured through a series of cone-beam computed tomography (CT) scans. A three-dimensional heterogeneous nonlinear FE model was constructed based on the CT images of this patient, and the in-vivo BBT changes are correlated to the FE in-silico mechanobiological stimuli; namely, von Mises equivalent stress, equivalent strain, and strain energy density. The anterior incisory bone region of this model was then varied systematically to simulate five different BBTs (0.5, 1.0, 1.5, 2.0, and 2.5 mm), and the optimal BBT was inversely determined to minimize the risk of resorption. Results Significant changes in BBTs were observed clinically after 6 month loading on the implant. The pattern of bone resorption fell into a strong correlation with the distribution of mechanobiological stimuli onsite. The initial BBT appeared to play a critical role in distributing mechanobiological stimuli, thereby determining subsequent variation in BBT. A minimum initial thickness of 1.5 mm might be suggested to reduce bone resorption. Conclusions This study revealed that the initial BBT can significantly affect mechanobiological responses, which consequentially determines the bone remodeling process. A sufficient initial BBT is considered essential to assure a long-term stability of implant treatment.
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