Comparison of Stress Patterns in Edentulous Mandibular Bone around Two Implant Retained, Four Implant Retained Overdenture and All-On-Four Concept. - A 3 Dimensional Finite Element Analysis
Keywords:atrophic mandible, biomechanics, finite element analysis, implants supported prosthesis, tilted implants.
Recently the use of tilted implants has been considered as a preferable option in case of atrophic edentulous
arches. The tilted longer implants can be of use to ward off the important anatomical structures while also
permitting cantilever reduction.
Since the load transfer mechanism of an implant can be altered significantly by the number of implants
and its location in the edentulous ridge, the present study evaluates and compares the stress patterns in the
edentulous mandibular bone around two implant retained, four implant retained over denture and all on four
concepts under different loading conditions using finite element analysis.
Purpose: The biomechanical behaviour of the ‘All-On-Four’ system was compared with that of the two
implant-supported and four-implant supported mandibular overdenture using the three dimensional finite
element method (FEM). Thereby evaluating the von Misses stresses induced on the implants under different
Materials & Method: Three dimensional models representing mandible restored with ‘All-On-Four’, two
implant-supported and four-implant-supported prosthesis were developed in the three dimensional design
software and then transferred into FEM software. The models were then subjected to four different loading
simulations (full mouth biting, canine disclusion, load on cantilever, load in the absence of cantilever). The
maximum von Mises stresses were localized and quantified for comparison.1
Results: Among the three models, under all loading simulations, the maximum stress concentrations werealong the neck of the
implant. The stress levels for full mouth loading simulation was highest for twoimplant supported overdenture design and the
least for All-On-Four overdenture design. In all three designs,the least stress was when the implants were loaded in a lateral
direction. The stress levels for cantilever andnon-cantilevered designs were nearly the samefor all the simulated designs.
Conclusion: When tested under differentloading simulations, the three modelsshowed similar location and distribution ofstress
patterns. Thus from the study it can beconcluded that the All-On-Four Concept is a clinically applicable treatment option for the
atrophic edentulous ridges and induces least amount of stresseson the edentulous ridges. Therefore the overall longevity of the
prosthesis is greatly enhanced.
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