From mechanical models to clinical reality: A systematic review of finite element advances in dental implant design, biomechanics, and optimization

This systematic review analyzes 278 finite element studies on dental implants selected for clear reporting of geometry, material properties, loading conditions, and research aims. The synthesis revealed strong consistency among findings: larger implant diameters and lengths generally reduced peri-implant bone stress; optimized thread designs improved stress distribution; oblique loading increased stress compared to axial loading; splinted restorations reduced stress; and internal or conical connections performed better than external-hex designs. Each study was further evaluated against 20 realism-enhancing parameters, including patient-specific anatomy, anisotropic bone modeling, nonlinear material behavior, dynamic loading, screw preload, frictional contact, fatigue and remodeling analysis, and uncertainty quantification. These parameters collectively improve anatomical fidelity, mechanical accuracy, and predictive reliability by incorporating realistic biological and mechanical behavior into simulations. Despite growing methodological sophistication, adoption of these parameters remains limited. The review highlights substantial agreement on geometry and load-related outcomes but emphasizes the need for broader implementation of the 20 key parameters to strengthen the predictive value of finite element models for long-term implant performance. • Finite element methods were reviewed for implant stress analysis. • Dental implant designs were critically evaluated. • Biomechanical factors were analyzed using FEM simulations. • Recent advancements were reviewed for improving implant design.