All-on-4 concept: a 3-dimensional finite element analysis

Biomechanical behavior of all-on-4 concept and alternative designs under different occlusal load configurations for completely edentulous mandible: a 3-D finite element analysis

The aim of this study was to evaluate the effect of the All-on-4 design and 4 alternative implant-supported fixed prosthesis designs on stress distribution in implants, peri-implant bone, and prosthetic framework in the edentulous mandible under different loading conditions using three-dimensional finite element analysis (3D-FEA).Five different experimental finite element models (Model A (unsplinted 6), Model B (splinted 6), Model C (All-on-4), Model D (axial; 2 anterior, 2 posterior), and Model E (4 interforaminal)) were created. Three different loading conditions were applied (canine loading, unilateral I-loading, and unilateral II-loading). The highest minimum (Pmin) and the maximum (Pmax) principal stress values were acquired for cortical and trabecular bones; the highest von Mises (mvM) stress values were obtained for implants and metal frameworks. Model B and Model D showed the most favorable stress distribution. The All-on-4 design (Model C) also showed acceptable stress values close to those of Model B and Model D in the cortical and trabecular bones. In accordance with the stress values in the bone structure, the lowest stress values were measured in the implants and Co-Cr framework in Model B and Model D. The highest stress values in all structures were measured for unilateral loading- II, while the lowest values were found for canine loading. It was concluded that Model B and Model D experimental models showed better biomechanical performance in all structures. Furthermore, the use of a splinted framework, avoiding cantilevers, results in lower stress transmission. On the other hand, canine loading and unilateral loading-I exhibited the best loading conditions.

A finite element analysis study on different angle correction designs for inclined implants in All-On-Four protocol

BACKGROUND

The aim of this study is to investigate, through finite element analysis (FEA), the biomechanical behavior of the built-in angle corrected dental implant versus implant with angled multiunit abutment used in All-On-Four treatment protocol.

METHODS

Two (3D) finite element models of a simplified edentulous mandible were constructed with two different posterior implant designs based on the All-On-Four protocol. Four implants were placed in each model, the two anterior implants were positioned vertically at the lateral incisor/canine sites. Depending on the implant fixture design in posterior area, there are two models created; Model I; the mandible was rehabilitated with four co-axis (4 mm in diameter × 15 mm in length) implants with distally built-in angle corrected implants (24-degree angle correction) .While Model II, the mandible was rehabilitated with four conventional (4 mm in diameter × 14 mm in length) implants with a distally inclined posterior implants (25 degree) and angled multiunit abutments. CAD software (Solidworks© 2017; Dassault Systems Solidworks Corp) was used to model the desired geometry. Axial and inclined Loads were applied on the two models. A Finite element analysis study was done using an efficient software ANSYS© with specified materials. The resultant equivalent Von-Misses stresses (VMS), maximum principal stresses and deformation analysis were calculated for each part (implants and prosthetic components).

RESULTS

When applying axial and non-axial forces, model II (angled multiunit model) showed higher deformation on the level of Ti mesh about 13.286 μm and higher VMS 246.68 MPa than model I (angle corrected implant). Model I exhibited higher maximum stresses 107.83 MPa than Model II 94.988 MPa but the difference was not statistically significant.

CONCLUSION

Within the limitation of the FEA study, although angle correcting implant design is showing higher values in maximum principle stresses compared with angled multiunit abutments, model deformation and resultant VMS increased with angled multiunit abutments. The angle correcting designs at implant level have more promising results in terms of deformation and VMS distribution than angle correction at abutment level.

Stress distribution pattern in all-on-four maxillary restorations supported by porous tantalum and solid titanium implants using three-dimensional finite element analysis

Success/failure of dental implants depends on stress transfer and distribution at the bone-implant interface. This study aimed to assess the stress distribution pattern in all-on-four maxillary restorations supported by porous tantalum and solid titanium implants using three-dimensional (3D) finite element analysis (FEA). In this FEA, a geometric model of an edentulous maxilla, Zimmer screw-vent tantalum and solid titanium implants were modelled. Four models with the all-on-four concept were designed. The fifth model had 6 vertical implants (all-on-six). Two different implant types (porous tantalum and solid titanium) were modelled to yield a total of 10 models, and subjected to 200 N bilateral vertical load. Pattern of stress distribution and maximum von Mises stress values in cancellous and cortical bones around implants were analysed. In tantalum models, the effect of increasing the distal tilting of posterior implants was comparable to the effect of increasing the number of implants to 6 on von Mises stress values in cortical bone. However, in cancellous bone, the effect of increasing the tilting of posterior implants on stress was slightly greater than the effect of increasing the number of implants to 6. In solid titanium models, the effect of both of the abovementioned parameters was comparable on stress in cancellous bone; but in cortical bone, the effect of increasing the implant number was slightly greater on stress reduction. Despite similar pattern of stress distribution in bone around implants, higher maximum von Mises stress values around tantalum implants indicate higher stress transfer capacity of this type of implant to the adjacent bone, compared with solid titanium implants.

Biomechanical investigation of maxillary implant-supported full-arch prostheses produced with different framework materials: a finite elements study

PURPOSE

Four and six implant-supported fixed full-arch prostheses with various framework materials were assessed under different loading conditions.

MATERIALS AND METHODS

In the edentulous maxilla, the implants were positioned in a configuration of four to six implant modalities. CoCr, Ti, ZrO₂, and PEEK materials were used to produce the prosthetic structure. Using finite element stress analysis, the first molar was subjected to a 200 N axial and 45° oblique force. Stresses were measured on the bone, implants, abutment screw, abutment, and prosthetic screw. The Von Mises, maximum, and minimum principal stress values were calculated and compared.

RESULTS

The maximum and minimum principal stresses in bone were determined as CoCr < ZrO₂ < Ti < PEEK. The Von Mises stresses on the implant, implant screw, abutment, and prosthetic screws were determined as CoCr < ZrO₂ < Ti < PEEK. The highest Von Mises stress was 9584.4 Mpa in PEEK material on the prosthetic screw under 4 implant-oblique loading. The highest maximum principal stress value in bone was found to be 120.89 Mpa, for PEEK in 4 implant-oblique loading.

CONCLUSION

For four and six implant-supported structures, and depending on the loading condition, the system accumulated different stresses. The distribution of stress was reduced in materials with a high elastic modulus. When choosing materials for implant-supported fixed prostheses, it is essential to consider both the number of implants and the mechanical and physical attributes of the framework material.

Stresses induced by one piece and two piece dental implants in All-on-4® implant supported prosthesis under simulated lateral occlusal loading: non linear finite element analysis study

Background

Correct choice of the implant design and the occlusal scheme is important for the success of implant supported restorations. So, the aim of the current study was to find out the difference in the stresses induced by the one piece dental implants designed to be used in the All-on-4® concept and the conventional two piece ones under simulated lateral occlusal schemes using nonlinear finite element analysis.

Methods

Two finite element models of the maxilla, implants, and prostheses were designed according to the All-on-4® concept. In the model TP, two piece dental implants were placed while in the model OP one piece dental implants were used. Two loading scenarios were applied to each model; the first one simulated a group function occlusal scheme while the second scenario simulated a canine guided one.

Results

The highest stress value was recorded in the model TP with the group function occlusion and the lowest stress value was in the model OP with the canine guidance occlusion.

Conclusion

The one-piece dental implants can be concluded to induce less stress compared to the two piece dental implants when used in the All-on-4® implant supported prosthesis in the different lateral occlusal schemes. Canine guided occlusion can be concluded to cause lower stress values in comparison to the group function occlusal scheme.

How do implant threads and diameters affect the all-on-four success? A 3D finite element analysis study

BACKGROUND: The effect of different thread designs and diameters on the all-on-four concept is unclear. OBJECTIVE: The aim of the study was to clarify the differences in stress distribution of dental implants with various thread designs and diameters based on the all-on-four concept with three dimensional (3D) finite element analysis (FEA). METHODS: A 3D model of a totally edentulous mandible was used to perform the FEA. Four different models (M1, M2, M3, and M4) including 3.5 and 4.3 mm diameter dental implants with active and passive threaded designs were generated. The dental implants were positioned according to the all-on-four concept. The Von Mises stresses on dental implants and maximum and minimum principal stresses (Pmax and Pmin) on bony structures were calculated under vertical, oblique and horizontal loads. RESULTS: For Von Mises stresses, the highest stress values were detected on the distal implants for all models. Distal implants had also the highest stress values for vertical loading. The Von Mises stresses were found to be concentrated around the implant’s neck. In all models the highest Pmax and Pmin stresses occurred in the bone surrounding the distal implant. It was noted that the active threaded implants showed the highest Pmax and Pmin stress values. CONCLUSION: The implant thread design and diameter might have a strong influence on the stress values in the all-on-four concept.

A comparative evaluation of stress distribution between an All-on-Four implant-supported prosthesis and the Trefoil implant-supported prosthesis: A three-dimensional finite element analysis study

Aim

The primary aim of this study is to analyse the stress distribution between an ALL ON FOUR implant supported prosthesis and the TREFOIL implant supported prosthesis with 3D finite element models.

Settings and Design

An in vitro perspective.

Materials and Methods

Two mandibular three-dimensional Finite Element Models were constructed by the CREO version 5 software, in which Model A depicts a mandible with ALL ON FOUR implant supported prost hesis and Model B will depict TREFOIL implant supported prosthesis. Model A contains four implants, two anterior straight and posterior tilted implants (30°), a bar and denture containing acrylic teeth. In Model B, it contains three straight implants and a prefabricated compensatory bar with standardised dimensions. To evaluate and compare the stress distribution between the bone and implant interface, one deleterious cantilever load of upto 300 N is applied on the second molar bilaterally and simultaneously. Another full bite biting load of 150 N is given bilaterally and simultaneously on the central groove of premolars and molars.

Statistical Analysis Used

The results of the simulations obtained were analysed in terms of Von Mises equivalent stress levels at the bone -implant interface.

Results

The results of loading 1 showed that the maximum Von Mises stress was recorded in the anterior implant region of the Trefoil system (Model B) when compared to All on four concept. The results of loading 2 showed that the maximum Von Mises stress were recorded in the anterior implant region Trefoil system (Model B) when compared to All on four concept.

Conclusion

This invitro study concludes that All on Four implant supported prosthesis showed better stress distribution when compared to the Trefoil concept.

Biomechanical Behavior of All-on-4 and M-4 Configurations in an Atrophic Maxilla: A 3D Finite Element Method

BACKGROUND In edentulous patients, the concept of 4 implants with early loading has been widely used in clinical settings. In the case of bone atrophy in the anterior maxilla, using short implants or an angulated implant may be a good choice for treatment. The occlusal scheme remains a key aspect of All-on-4. The aim of this study was to use the 3-dimensional (3D) finite element method (FEM) to evaluate how different All-on-4 designs for canine-guided and group function occlusion affected the distribution of stress in the atrophic premaxilla. MATERIAL AND METHODS A 3D edentulous maxilla model was created and in 3D FEM, 3 different configurations - M4, All-on-4, and short implant - were modeled by changing the anterior implants and using 2 different occlusal schemes. For each model, the occlusal load was applied to simulate lateral movements. For cortical bone, the maximum and minimum principal stress values were generated, and for ductile materials, von Mises stress values were obtained. RESULTS No significant differences were detected among the models; generally, however, the highest stress values were observed in the M-4 model and the models with short implants. Slightly higher stress values were observed in the group function occlusion group than in the canine-guided occlusion group. CONCLUSIONS To promote better primary stabilization, M-4 or short implant configurations with canine-guided occlusion appear to be preferable for patients who have severe atrophy in the anterior maxilla.

Biomechanical properties of the bone during implant placement

Background

In this research the biomechanical properties of a bone model was examined. Porcine ribs are used as experimental model. The objective of this research was to investigate and compare the biomechanical properties of the bone model before and after implant placement.

Methods

The bone samples were divided in three groups, Group 1 where ALL-ON-FOUR protocol was used during pre-drilling and placing the implants, Group 2 where ALL-ON-FOUR protocol was used during pre-drilling, and implants were not placed, and Group 3 consisting of intact bones served as a control group. Static and dynamic loading was applied for examining the model samples. Kruskal–Wallis statistical test and as a post-hoc test Mann–Whitney U test was performed to analyze experimental results.

Results

According to the results of the static loading, there was no significant difference between the implanted and original ribs, however, the toughness values of the bones decreased largely on account of predrilling the bones. The analysis of dynamic fatigue measurements by Kruskal–Wallis test showed significant differences between the intact and predrilled bones.

Conclusion

The pre-drilled bone was much weaker in both static and dynamic tests than the natural or implanted specimens. According to the results of the dynamic tests and after a certain loading cycle the implanted samples behaved the same way as the control samples, which suggests that implantation have stabilized the skeletal bone structure.

Effects of Occlusal Scheme on All-on-Four Abutments, Screws, and Prostheses: A Three-Dimensional Finite Element Study

An ideal occlusal scheme plays an important role in a good prognosis of All-on-Four applications, as it does for other implant therapies, because of the potential impact of occlusal loads on implant prosthetic components. The aim of the present 3D finite element analysis (FEA) study was to investigate the stresses on abutments, screws, and prostheses that are generated by occlusal loads via different occlusal schemes in the All-on-Four concept. 3D models of the maxilla, mandible, implants, implant substructures, and prostheses were designed according to the All-on-Four concept. Forces were applied from the occlusal contact points formed in maximum intercuspation and eccentric movements in canine guidance occlusion (CGO), group function occlusion (GFO), and lingualized occlusion (LO). The von Mises stress values for abutment and screws and deformation values for prostheses were obtained, and results were evaluated comparatively. It was observed that the stresses on screws and abutments were more evenly distributed in GFO. Maximum deformation values for prosthesis were observed in the CFO model for lateral movement both in the maxilla and mandible. Within the limits of the present study, GFO may be suggested to reduce stresses on screws, abutments, and prostheses in the All-on-Four concept.

A finite element analysis to study the stress distribution on distal implants in an all-on-four situation in atrophic maxilla as affected by the tilt of the implants and varying cantilever lengths

Aim:

The aim of this work was to evaluate stress distribution on implants in All-on-Four situation with varying distal implant angulations (30°,40°,45°) and varying cantilever lengths (4 mm, 8 mm, 12 mm, 16 mm) in atrophic maxilla using finite element analysis.

Setting and Design:

A in vitro study, finite element analysis.

Materials and Methodology:

Three-dimensional finite element model of an edentulous maxilla restored with a prosthesis supported by four implants was reconstructed to carry out the analysis. Three different configurations, corresponding to 3 tilt degrees of the distal implants (30°, 40°, and 45°) were subjected to 4 loading simulations.

Statistical Analysis Used:

The results of the simulations obtained were evaluated in terms of Von Mises equivalent stress levels at the bone-implant interface.

Result:

From a stress-level viewpoint, the 45° model was revealed to be the most critical for peri-implant bone. In all the loading simulations, the maximum stress values were always found at the neck of the distal implants. With increasing distal implant tilt, cantilever length reduces depending on the quality of bone. At 30° angulation of distal implant a maximum cantilever length of 16 mm may be given if the quality of bone is D3 but only 8 mm cantilever may be recommended if bone quality is D4. At 40° angulation, 16 mm in D3 bone and 0 mm in D4 bone whereas at 45° angulation, it reduces to 12 mm in D3 bone and no cantilever is recommended with D4 bone.

Conclusion:

The 45° tilt induced higher stress values at the bone-implant interface, especially in the distal aspect, than the other 2 tilts analyzed. Stress values increased with increased cantilever length which was further influenced by the distal implant tilt and the quality of the bone.

Biomechanical comparison of the All-on-4, M-4, and V-4 techniques in an atrophic maxilla: A 3D finite element analysis

BACKGROUND

Patients with severely atrophied jaws can be challenging in implantology. The All-on-4 treatment concept eliminates advanced augmentation procedures in highly resorbed ridges by preserving the relevant anatomic structures. In addition, the inclination of the distal implants enables the placement of longer implants. Hence, tilting the anterior implants allows longer implant placement, in line with the distal implants of the All-on-4 concept. This study compared the biomechanical aspects of the standard All-on-4 treatment concept with the M-4 and V-4 techniques.

METHODS

A three-dimensional model of an edentulous maxilla was created to perform three-dimensional finite element analysis. Three different configurations (All-on-4, M-4, and V-4) were modeled by changing the tilt angle of the anterior implants. In each model, to simulate a foodstuff, a solid spherical material was placed on the midline of the incisors and the right first molar region, separately applying an occlusal load of 100 Newtons. The maximum principal stress and minimum principal stress values were acquired for cortical bone, and von Mises stress values were obtained for ductile materials.

RESULTS

According to the present study's findings, although there were no considerable differences among the models, in general, the All-on-4 group demonstrated slightly higher stresses and the M-4 and V-4 group showed lower stresses.

CONCLUSION

M-4 or V-4 configurations may be used in cases of severely atrophied anterior maxillae to achieve better primary stabilization.

The Influence of Custom-Milled Framework Design for an Implant-Supported Full-Arch Fixed Dental Prosthesis: 3D-FEA Sudy

The current study aimed to evaluate the mechanical behavior of two different maxillary prosthetic rehabilitations according to the framework design using the Finite Element Analysis. An implant-supported full-arch fixed dental prosthesis was developed using a modeling software. Two conditions were modeled: a conventional casted framework and an experimental prosthesis with customized milled framework. The geometries of bone, prostheses, implants and abutments were modeled. The mechanical properties and friction coefficient for each isotropic and homogeneous material were simulated. A load of 100 N load was applied on the external surface of the prosthesis at 30° and the results were analyzed in terms of von Mises stress, microstrains and displacements. In the experimental design, a decrease of prosthesis displacement, bone strain and stresses in the metallic structures was observed, except for the abutment screw that showed a stress increase of 19.01%. The conventional design exhibited the highest stress values located on the prosthesis framework (29.65 MPa) between the anterior implants, in comparison with the experimental design (13.27 MPa in the same region). An alternative design of a stronger framework with lower stress concentration was reported. The current study represents an important step in the design and analysis of implant-supported full-arch fixed dental prosthesis with limited occlusal vertical dimension.

Stress Distribution on the Prosthetic Screws in the All-on-4 Concept: A Three-Dimensional Finite Element Analysis

The all-on-4 concept, which is used to rehabilitate edentulous patients, can present with mechanical complications such as screw loosening and fracture. The purpose of this study was to evaluate the stress patterns induced in the prosthetic screws by the different prosthetic screw and abutment designs in the all-on-4 concept using finite element analysis. Von Mises stress values on 6 groups of each screw type, including short and narrow screw, short abutment; short and wide screw, short abutment; long and wide screw, short abutment; short and narrow screw, long abutment; short and wide screw, long abutment; and long and wide screw, long abutment, were compared under a cantilever loading of 200 N that was applied on the farther posterior to the position of the connection between the distal implant and the metal framework. Posterior prosthetic screws showed higher stress values than anterior prosthetic screws. The stress values in posterior prosthetic screws decreased as the length and diameter increased. In conclusion, the long and wide screw design offers advantages in stress distribution when compared with the short and narrow design.

[Development of tilted implant for free end of maxillary posterior teeth]

Vertical bone insufficiency in the maxillary posterior teeth is a common clinical situation. At present, the bone insufficiency in the maxillary posterior teeth is mainly overcome by bone grafting through maxillary sinus floor elevation. Compared with traditional axial implantation, tilted implantation can better avoid bone grafting, reduce complications, shorten the treatment cycle, reduce the treatment cost for patients, and gradually be promoted in clinical settings. This article reviews the concept, biomechanics, clinical evaluation, and digital trend of tilted implants of maxillary posterior teeth.

Finite element analysis of stress concentration between surface coated implants and non surface coated implants - An in vitro study

Background

To determine qualitative comparison in stress distribution between surface coated implants and non surface coated implants using 2 different lengths and vertical, oblique, and lateral forces.

Material and Methods

3 dimensional finite element study was carried out at first molar site with 4 surface coated and 4 non surface coated implants using mimic 8.11, solid edge 2004, hypermesh 9.0, and ansys12.1 software.

Results

The pattern of stress distribution was almost similar between vertical and oblique loading but varied with lateral loads between surface coated and non surface coated implants. As the length of the implants increased stress concentration had no significant variation between surface coated and non surface coated implants, but had a tendency to increase at the abutment and abutment screw on all 3 forces.

Conclusions

Among the surface coated and non surface implants the pattern of stress distribution was similar signifying that surface coating of implants had no significant role in stress distribution using 3d finite element analysis and within the limitations of this study.

Key words:Surface coating, non surface coating, implants, stress and bone.

Clinical assessment of implant-supported full-arch immediate prostheses over 6 months of function

OBJECTIVE

To assess the clinical outcomes of implant-supported full-arch immediate prosthesis over 6 months of functions and analyze the risk factors of prosthetic complications.

MATERIALS AND METHODS

This retrospective cohort study included patients who were treated with implant-supported full-arch restoration under immediate loading protocol between April 2008 and June 2016, and who wore the immediate prosthesis for more than 6 months. Medical charts were reviewed for the patients' general information, implant information, prosthetic information, and details of any prosthetic complications. Prosthetic complications were classified as follows: class I, prosthesis loosening; class II, fewer than three artificial teeth fractured; class III, three or more artificial teeth fractured; and class IV, resin base fractures. A cox proportional hazards ratio model was adopted to analyze the potential risk factors for class IV complications.

RESULTS

A total of 114 patients (mean age, 56.73 ± 10.19 years) and 144 prostheses were included. The average wearing time for the immediate prosthesis was 21.9 months, and 62 (54.39%) patients experienced prosthetic complications, 30 of whom suffered from complications more than once. The most common complications were class II complications (12.3%) during the first 6 months of functioning and class IV complications (28.1%) during the entire function period. Class II complications were more common in the anterior region, while class IV complications occurred more often in the posterior region. The multivariable Cox proportional hazards regression model showed that a prosthesis in the maxilla (HR = 3.37, P = .001) and fiber reinforcement (HR = 0.39, P = .021) were significantly related to class IV complications.

CONCLUSIONS

Implant-supported full-arch immediate prosthesis functioning over 6 months have a high prevalence of prosthetic complications. Fiber-reinforcement could reduce the prevalence of class IV complications when acrylic immediate prosthesis functioned longer than 6 months. Avoiding using the anterior teeth of the immediate prosthesis to tear pliable but strong food may prevent tooth fracture.

Biomechanical Behavior of an Implant System Using Polyether Ether Ketone Bar: Finite Element Analysis

Aim and Objectives:

This study assessed, through finite element analysis, the biomechanical behavior of an implant system using the All-on-Four^® technique with nickel–chromium (M1) and polyether ether ketone (PEEK) bars (M2).

Materials and Methods:

Implants and components were represented in three-dimensional (3D) geometric models and submitted to three types of load: axial, oblique, and load on all teeth. The 3D models were exported to a computer-aided design-like software such as Solidworks 2016 (Dassault Systemes, Solidworks Corps, USA) for editing and Nonuniform Rational Basis Splines parametrization.

Results:

Data were analyzed according to system's areas of action: peri-implant bone, implant, intermediates, intermediates’ screws, prostheses’ screws, and bars. Largest peak stress was shown in M2.

Conclusion:

PEEK is a promising material for use in dentistry; however, further studies are necessary to evaluate its performance.

Digital versus Traditional Workflow for Posterior Maxillary Rehabilitations Supported by One Straight and One Tilted Implant: A 3-Year Prospective Comparative Study

Objectives

The aim of the study was to evaluate and compare digital and traditional prosthetic workflow for posterior maxillary restorations supported by an upright and a distally tilted implant at 3-year follow-up.

Materials and Methods

Twenty-four patients were treated in the posterior maxilla with 24 immediately loaded axial and 24 distally tilted implants supporting 3-unit or 4-unit screw-retained prostheses. Three months after initial loading patients were randomly stratified into two groups: definitive traditional impressions were carried out in the control group, while digital impressions were performed in the test group. The framework-implant connection accuracy was evaluated by means intraoral digital radiographs at 3, 6, 12, and 36 months of follow-up examinations. Outcome considerations comprised implant and prosthetic survival and success rates, marginal bone level changes, and required clinical time to take impressions.

Results

A total of 24 patients received immediately loaded screw-retained prostheses supported by an upright and a distally tilted implant (total 48 implants). No implant dropouts occurred, showing an overall survival rate of 100% for both groups. None of the 24 fixed prostheses were lost during the observation period (prosthetic survival rate of 100%). No statistically significant differences in marginal bone loss were found between control and test groups. The digital impression procedure required on average less clinical time than the conventional procedure.

Conclusions

Clinical and radiologic results suggest that digital impression is a predictable procedure for posterior maxillary restorations supported by an upright and a distally tilted implant.

Influence of different implant-abutment connections on stress distribution in single tilted implants and peripheral bone: A three-dimensional finite element analysis

BACKGROUND

The load transfer between the implant-bone interface depends on various factors, including loading type; material properties of the implant and prosthesis; and implant geometry, length, diameter, and shape.

OBJECTIVE

The purpose of this study was to evaluate stress distribution in single tilted bone-level implants with different connections and peripheral bone under vertical and oblique loads using three-dimensional (3D) finite element analysis (FEA).METHOS.3D models of four different implant systems and their abutments were created from the data (computer-aided design) of original implants and abutments scanned with an optical scanner. The implants were placed in the bone block at degrees of 0°, 15°, and 30°. Then, a 3D model of the metal-ceramic crown was created and a 100-N total load was applied vertically and obliquely.

RESULTS

Stress analyses showed variable results depending on the connection design and tilting angle; however, the tube in tube (TIT) connection type exhibited lower stress values in most loading and tilting simulations.

CONCLUSIONS

Increase in tilting angle showed variable results in each connection design. The TIT connection design was found to be more successful in terms of stress distributions in the implant components and the peripheral bone.

Prefabricated Bar System for Immediate Loading in Edentulous Patients: A 5-Year Follow-Up Prospective Longitudinal Study

Objectives

The aim of this clinical study was to evaluate a new type of prefabricated bar system, supported by axial and tilted implants at 5-year follow-up.

Materials and Methods

Twenty-nine consecutive participants (19 females, 10 males) (mean age 61.4 years), edentulous in one or both jaws, with severe atrophy of the posterior regions, were treated according to the All-on-four® protocol with immediately loaded axial (64) and tilted (64) implants supporting complete-arch screw-retained prostheses (12 maxillary, 20 mandibular) featuring a prefabricated bar as framework. Follow-up visits were performed at 3, 6, 12, 24, 48, and 60 months after implant insertion. Radiographic assessments were made using panoramic radiographs obtained immediately after surgery and at each follow-up visit. Bone level measurements around the axial and tilted implants were compared by means of the Student's t-test.

Results

One axial implant failed in the lower jaw and did not compromise prosthetic function. The 60-month overall implant survival rate was 100% for axially positioned implants and 98.44% for tilted implants. The implant survival rates were 100% in the maxilla and 98.75% in the mandible. None of the 32 fixed prostheses were lost during the observation period, representing a prosthetic survival rate of 100%. No statistically significant differences (P > 0.05) in marginal bone loss between tilted and axial implants were detected in either jaw over time.

Conclusions

The use of the evaluated prefabricated bar for immediately loaded implants placed according to the All-on-four concept may significantly reduce implant failures; however, more long-term prospective clinical trials are needed to affirm the effectiveness of the surgical-prosthetic protocol.