Finite element analysis in dentistry: a comprehensive narrative review of biomechanical principles, clinical...

Finite Element Analysis (FEA) is a well-established numerical modelling technique increasingly adopted in dental research to model the biomechanical behaviour of oral structures under functional and parafunctional loading conditions. This narrative review aims to (1) trace the historical development of FEA from its engineering origins to dental applications, (2) describe the methodological framework of FEA with emphasis on dental-specific modelling considerations, (3) comprehensively survey current applications across all major dental specialties, and (4) critically appraise the technical challenges and limitations inherent to dental FEA. A narrative literature search was conducted across PubMed/MEDLINE, Scopus, EMBASE, the Cochrane Library, and Google Scholar using the terms "finite element analysis," "FEA," "dental biomechanics," and "stress distribution," combined with specialty-specific MeSH headings. Articles published in English from 1969 to June 2026 were considered. Inclusion criteria were primary FEA research articles, systematic reviews, and authoritative biomechanics textbooks. Exclusion criteria were non-English language publications, conference abstracts without full-text availability, and studies involving non-dental anatomical sites exclusively. No formal PRISMA-based systematic process was applied, consistent with the narrative review format; this review was not prospectively registered. FEA has demonstrated substantial methodological utility as a hypothesis-generating and design-optimisation tool across implantology, orthodontics, endodontics, prosthodontics, periodontics, oral and maxillofacial surgery, restorative dentistry, paediatric dentistry, and temporomandibular joint disorders; however, much of the available literature remains computational and hypothesis-generating rather than clinically validated. Key applications include peri-implant stress distribution modelling, orthodontic force optimisation, endodontic instrument fatigue prediction, and prosthetic material selection. Persistent limitations include oversimplification of biological tissue properties, absence of validated dynamic loading models, and lack of inter-study standardisation. The quality of FEA outputs is critically dependent on the accuracy of geometry reconstruction, the completeness of material property assignment, the realism of loading conditions, and the presence of experimental model validation. FEA is a valuable tool in evidence-based dental research, enabling non-invasive, patient-specific biomechanical simulation. Advances in CBCT imaging, AI-assisted meshing, and high-performance computing are progressively addressing existing limitations and expanding clinical translatability.