The effect of mandibular flexure on the design of implant-supported fixed restorations of different facial types under two loading conditions by three-dimensional finite element analysis

Abstract

Objective: Investigating the biomechanical effects of mandibular flexure (MF) on the design of implant-supported fixed restorations in edentulous jaws of different facial types.Methods: Three-dimensional finite element models were established to analyze mandibular displacement and stress distribution of implant-supported fixed restorations (four or six implants, different implant numbers and sites, and the design of the superstructure across the dental arch in one or two or three pieces, under the loading conditions of maximum opening or right unilateral molar occlusion) in mandibular edentulous patients of three different facial types (brachyfacial, mesofacial, and dolichofacial types).Results: The brachyfacial type presented higher mandibular flexure and stress in the overall restorative system, followed by the mesofacial and dolichofacial types. During jaw opening and occlusal movements, the one-piece framework showed the lowest bone stress values surrounding the anterior implants and gradually increased to the distal position, and the three-piece framework showed the highest stress values for peri-implant bones. Also, the split framework could greatly increase the stress on abutments and frameworks. Moreover, fixed implant prostheses with cantilevers can generate high amounts of biomechanical stress and strain on implants and surrounding bones. The bone surrounding the anterior implant increased in stress values as the most distal implants were more distally located regardless of frameworks. The zirconia framework demonstrated higher stresses than the titanium framework.Conclusion: The design of edentulous fixed implant-supported restorations can be optimized for facial types. For patients of the brachyfacial type or with high masticatory muscle strength, the non-segmented framework without a cantilever provides an optimal biomechanical environment.

Maxillary Cast Partial Denture and Mandibular Implant-Supported Metal-Ceramic Prosthesis With a Split Framework to Compensate for Mandibular Flexure: A Case Report

“…However, as per a few studies, the necessity of a segmented framework for implant-supported fixed prostheses is currently debated [ 4 , 19 ]. A non-segmented prosthesis could be given if the implant-supported fixed restoration is without a cantilever and if it provides an optimal biomechanical environment with good resistance offsetting the effects of mandibular flexure, especially in cases of the posterior single unilateral framework [ 4 , 20 ].…”

Retrospective digital study of mandibular flexure in patients with long-span fixed restorations supported by natural teeth

“…This study recommends that the design of a long-span fixed prosthesis should be segmented, if possible, to allow mandibular flexure, as indicated by many previous studies [ 35 , 36 ].…”

Biomechanical Implications of Mandibular Flexion on Implant-Supported Full-Arch Rehabilitations: A Systematic Literature Review

“…Nevertheless, Shinkai et al ruled out a significant influence of facial type on MMF, arguing that, given the small size and not excessive strength of the lateral pterygoid muscle, muscular strength plays a secondary role with respect to the resistance of the bone structure to mandibular deformation [ 33 ]. The recent study by Gao, J. et al evaluated for the first time the morphological-functional response to mandibular flexion of implant-supported prostheses in different facial types, showing that not only is mandibular deformation greater in brachial patients, but that different clinical arrangements are required than in meso and dolicho patients [ 76 ].…”