Int J Oral Maxillofac Implants 26 (2011), No. 4 15. Aug. 2011
Purpose: The distribution of stresses in bone, implants, and prosthesis were analyzed via three-dimensional finite element modeling in different implant configurations for a fixed implant-supported prosthesis in an edentulous mandible.
Materials and Methods: A finite element model was created with data obtained from computed tomographic scans of a human mandible. Anisotropic characteristics for cortical and cancellous bone were incorporated into the model. Six different configurations of intraforaminal implants were tested, with the number of implants varying from three to five and the distal implants inserted either parallel to the other implants or tilted distally by 17 or 34 degrees. A prosthetic structure connecting the implants was designed, with 20-mm posterior cantilevers for the parallel implant configurations, and a load of 200 N was applied to the distal portion of the cantilevers. Stresses were measured at the level of the implant, the prosthetic structure, and the bone. Bone-level stresses were analyzed at the implant-bone interface, at the external cortical bone surface, distal to the terminal implant, and in the cancellous bone along the implant body.
Results: A three-parallel-implant configuration resulted in higher stress in the implant and bone than configurations with four or five parallel implants. Configurations with the distal implants tilted resulted in a more favorable stress distribution at all levels.
Conclusion: In parallel-implant configurations for fixed implant-supported mandibular prostheses, four and five implants resulted in similar stress distribution in the bone, framework, and implants. A distribution of four implants with the distal implants tilted 34 degrees (ie, the "All-on-Four" configuration) resulted in a favorable reduction of stresses in the bone, framework, and implants.
Keywords: anisotropy, edentulous mandible, finite element analysis, implant prosthesis, stress distribution, tilted implants