Biomechanical comparison of four treatment models for the totally edentulous maxilla: a finite element analysis
Keywords:Finite element analysis; Dental implants; Edentulous jaw; Biomechanical phenomena.
The aim of this study is to evaluate by finite element analysis different techniques of totally edentulous maxilla rehabilitation, considering implants, bone tissue, metallic infra-structure, and prosthetic abutments characteristics, by means of a three-dimensional model. Stress distribution on bone tissue, implants, and abutments was analyzed with four configurations (six implants axially installed, all-on-four technique, M-4 technique, and four conventional implants with two zygomatic implants). Greater tension on bone tissue were found around distal implants, in all treatment groups, but not exceeding resistance limits of cortical bone. Von Mises stress was higher on the distal region of distal implants of all-on-four and M-4 techniques. Higher stress concentration was seen on angled abutments of zygomatic implants. The highest values of minimal compression stresses were concentrated on peri implant-bone tissue, especially in the model of All-on-4. Therefore, the present finite element analysis revealed that the four configurations of treatment (six implants axially installed, all-on-four technique, M-4 technique, and four conventional implants with two zygomatic implants) for the totally edentulous maxilla are feasible and safe, from a biomechanical point of view.
Almeida, E. O. De, Eduardo, M. S., Rocha, P., Júnior, A. C. F., & Júnior, M. M. (2010). Finite Element Stress Analysis of Edentulous Mandibles with Different Bone Types Supporting Multiple-Implant Superstructures. International Journal of Oral & Maxillofacial Implants, 25(6), 1108–1115.
Almeida, E. O., Rocha, E. P., Júnior, A. C. F., Anchieta, R. B., Poveda, R., Gupta, N., & Coelho, P. G. (2015). Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: A 3D-FEA biomechanical evaluation. Clinical Implant Dentistry and Related Research, 17(S1), e332–e342. https://doi.org/10.1111/cid.12129
Aparicio, C., Manresa, C., Francisco, K., Ouazzani, W., Claros, P., Potau, J. M., & Aparicio, A. (2014). The Long-Term Use of Zygomatic Implants: A 10-Year Clinical and Radiographic Report. Clinical Implant Dentistry and Related Research, 16(3), 447–459. https://doi.org/10.1111/cid.12007
Asawa, N., Bulbule, N., Kakade, D., & Shah, R. (2015). Angulated implants: An alternative to bone augmentation and sinus lift procedure: Systematic review. Journal of Clinical and Diagnostic Research, 9(3), ZE10–ZE13. https://doi.org/10.7860/JCDR/2015/11368.5655
Atwood, D. A. (1971). Reduction of residual ridges: A major oral disease entity. The Journal of Prosthetic Dentistry, 26(3), 266–279. https://doi.org/10.1016/0022-3913(71)90069-2
Balshi, T. J., Lee, H. Y., & Hernandez, R. E. (1995). The use of pterygomaxillary implants in the partially edentulous patient: a preliminary report. The International Journal of Oral & Maxillofacial Implants, 10(1), 89–98. https://doi.org/10.1057/9780230583375
Bhering, C. L. B., Mesquita, M. F., Kemmoku, D. T., Noritomi, P. Y., Consani, R. L. X., & Barão, V. A. R. (2016). Comparison between all-on-four and all-on-six treatment concepts and framework material on stress distribution in atrophic maxilla: A prototyping guided 3D-FEA study. Materials Science and Engineering C, 69, 715–725. https://doi.org/10.1016/j.msec.2016.07.059
Bozkaya, D., Muftu, S., & Muftu, A. (2004). Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite elements analysis. Journal of Prosthetic Dentistry, 92(6), 523–530. https://doi.org/10.1016/j.prosdent.2004.07.024
Bozyel, D., & Faruk, S. T. (2021). Biomechanical behavior of all-on-4 and M-4 configurations in an atrophic maxilla: A 3D finite element method. Medical Science Monitor, 27. https://doi.org/10.12659/MSM.929908
Brånemark, P. I., Gröndahl, K., Öhrnell, L. O., Nilsson, P., Petruson, B., Svensson, B., Engstrand, P., & Nannmark, U. (2004). Zygoma fixture in the management of advanced atrophy of the maxilla: Technique and long-term results. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 38(2), 70–85. https://doi.org/10.1080/02844310310023918
Brånemark, P. I., Svensson, B., & Van Steenberghe, D. (1995). Ten‐year survival rates of fixed prostheses on four or six implants ad modum Brånemark in full edentulism. In Clinical Oral Implants Research (Vol. 6, Issue 4, pp. 227–231). https://doi.org/10.1034/j.1600-0501.1995.060405.x
Brunski, J. B. (2014). Biomechanical aspects of the optimal number of implants to carry a cross-arch full restoration. European Journal of Oral Implantology, 7 Suppl 2, S111-31.
Calandriello, R., & Tomatis, M. (2005). Simplified Treatment of the Atrophic Posterior Maxilla via Immediate/Early Function and Tilted Implants: A Prospective 1-Year Clinical Study. Clinical Implant Dentistry and Related Research, 7(s1), s1–s12. https://doi.org/10.1111/j.1708-8208.2005.tb00069.x
Choi, A. H., Conway, R. C., & Ben-Nissan, B. (2014). Finite-element modeling and analysis in nanomedicine and dentistry. Nanomedicine, 9(11), 1681–1695. https://doi.org/10.2217/nnm.14.75
Chrcanovic, B. R., Albrektsson, T., & Wennerberg, A. (2016). Survival and Complications of Zygomatic Implants: An Updated Systematic Review. Journal of Oral and Maxillofacial Surgery, 74(10), 1949–1964. https://doi.org/10.1016/j.joms.2016.06.166
Eskitascioglu, G., Usumez, A., Sevimay, M., Soykan, E., & Unsal, E. (2004). The influence of occlusal loading location on stresses transferred to implant-supported prostheses and supporting bone: A three-dimensional finite element study. Journal of Prosthetic Dentistry, 91(2), 144–150. https://doi.org/10.1016/j.prosdent.2003.10.018
Haack, J. E., Sakaguchi, R. L., Sun, T., & Coffey, J. P. (1995). Elongation and preload stress in dental implant abutment screws. The International Journal of Oral & Maxillofacial Implants, 10(5), 529–536.
Jensen, O. T., & Adams, M. W. (2009). The Maxillary M-4: A Technical and Biomechanical Note for All-on-4 Management of Severe Maxillary Atrophy-Report of 3 Cases. Journal of Oral and Maxillofacial Surgery, 67(8), 1739–1744. https://doi.org/10.1016/j.joms.2009.03.067
Jensen, O. T., & Adams, M. W. (2014). Secondary Stabilization of Maxillary M-4 Treatment with Unstable Implants for Immediate Function: Biomechanical Considerations and Report of 10 Cases After 1 Year in Function. The International Journal of Oral & Maxillofacial Implants, 29(2), 232–240. https://doi.org/10.11607/jomi.te59
Lang, L. A., Kang, B., Wang, R. F., & Lang, B. R. (2003). Finite element analysis to determine implant preload. Journal of Prosthetic Dentistry, 90(6), 539–546. https://doi.org/10.1016/j.prosdent.2003.09.012
Maló, P., de Araújo Nobre, M., Lopes, A., Ferro, A., & Moss, S. (2015). Extramaxillary surgical technique: Clinical outcome of 352 patients rehabilitated with 747 zygomatic implants with a follow-up between 6 months and 7 years. Clinical Implant Dentistry and Related Research, 17(S1), e153–e162. https://doi.org/10.1111/cid.12147
Malo, P., Rangert, B., & Nobre, M. (2003). “All‐on‐Four” Immediate‐Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A Retrospective Clinical Study. Implant Dentistry, 5(Supplement I), 2–9. https://doi.org/10.1111/j.1708-8208.2003.tb00010.x
Malo, P., Rangert, B., & Nobre, M. (2005). All-on-4 immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clinical Implant Dentistry and Related Research, 7(SUPPL. 1), S88-94.
Mattsson, T., Köndell, P.-Å., Gynther, G. W., Fredholm, U., & Bolin, A. (1999). Implant treatment without bone grafting in severely resorbed edentulous maxillae. Journal of Oral and Maxillofacial Surgery, 57(3), 281–287. https://doi.org/10.1016/S0278-2391(99)90673-0
Peñarrocha-Oltra, D., Candel-Martí, E., Ata-Ali, J., & Peñarrocha-Diago, M. (2013). Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature. Journal of Oral Implantology, 39(5), 625–632. https://doi.org/10.1563/AAID-JOI-D-11-00068
Rodríguez, X., Lucas-Taulé, E., Elnayef, B., Altuna, P., Gargallo-Albiol, J., Peñarrocha Diago, M., & Hernandez-Alfaro, F. (2016). Anatomical and radiological approach to pterygoid implants: a cross-sectional study of 202 cone beam computed tomography examinations. International Journal of Oral and Maxillofacial Surgery, 45(5), 636–640. https://doi.org/10.1016/j.ijom.2015.12.009
Selna, L. G., Shillingburg, H. T., & Kerr, P. A. (1975). Finite element analysis of dental structures — axisymmetric and plane stress idealizations. Journal of Biomedical Materials Research, 9(2), 237–252. https://doi.org/10.1002/jbm.820090212
Silva, G. C., Mendonça, J. A., Lopes, L. R., & Landre, J. (2010). Stress patterns on implants in prostheses supported by four or six implants: a three-dimensional finite element analysis. The International Journal of Oral & Maxillofacial Implants, 25(2), 239–246.
Stella, J. P., & Warner, M. R. (2000). Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note. The International Journal of Oral & Maxillofacial Implants, 15(6), 889–893.
Tada, S., Stegaroiu, R., Kitamura, E., Miyakawa, O., & Kusakari, H. (2003). Influence of Implant Design and Bone Quality on Stress/Strain Distribution in Bone Around Implants: A 3-dimensional Finite Element Analysis. The International Journal of Oral & Maxillofacial Implants, 18(3), 357–368.
Vrielinck, L., Blok, J., & Politis, C. (2022). Survival of conventional dental implants in the edentulous atrophic maxilla in combination with zygomatic implants: a 20-year retrospective study. International Journal of Implant Dentistry, 8, 27. https://doi.org/10.1186/s40729-022-00425-3
Watson, R. M., Davis, D. M., Forman, G. H., & Coward, T. (1991). Considerations in design and fabrication of maxillary implant-supported prostheses. International Journal of Prosthodontics, 4(3), 232–239.
Weischer, T., Schettler, D., Mohr, C., Weisher, T., Schettler, D., & Mohr, C. (1997). Titanium implants in the zygoma as retaining elements after hemimaxillectomy. The International Journal of Oral & Maxillofacial Implants, 12(2), 211–214.
Yates, J. M., Brook, I. M., Patel, R. R., Wragg, P. F., Atkins, S. A., El-Awa, A., Bakri, I., & Bolt, R. (2014). Treatment of the edentulous atrophic maxilla using zygomatic implants: Evaluation of survival rates over 5-10 years. International Journal of Oral and Maxillofacial Surgery, 43(2), 237–242. https://doi.org/10.1016/j.ijom.2013.08.012
Zampelis, A., Rangert, B., & Heijl, L. (2007). Tilting of splinted implants for improved prosthodontic support: A two-dimensional finite element analysis. Journal of Prosthetic Dentistry, 97(6 SUPPL.). https://doi.org/10.1016/S0022-3913(07)60006-7
How to Cite
Copyright (c) 2022 Erton Massamitsu Miyasawa; Felipe Carvalho de Macêdo; Jorge Valenga Filho; Larissa Carvalho Trojan; Leandro Eduardo Klüppel; Luis Eduardo Marques Padovan
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.