Comparison of Extramaxillary Anchored Implants, Tilted Implants, or Sinus Elevation Concepts on Stress Distribution in Atrophic Maxilla: A Finite Element Analysis.

Abstract

To determine the von Mises stress values of extramaxillary implants anchored in zygomatic bone, known as zygomatic implants, abutments, superstructures, and principal stress values of bone under occlusal forces and to compare them with tilted implants and sinus elevation concepts. The hypothesis of the study was that there would be higher stress on zygomatic implants under occlusal forces compared with tilted implants and the sinus elevation technique due to the more angled placement of the zygomatic implants. Finite element analysis (FEA) was used to apply a force of 600 N (75 N premolars and 150 N first molar) vertically and at an angle of 20 degrees to the hybrid prosthesis with three different concepts-zygomatic implants, tilted implants, and sinus elevation-in D2 bones in six separate models. The posterior implants were tilted in zygomatic implant models (45 degrees) and tilted implant models (30 degrees). The von Mises and principal stress values formed in the models were compared by FEA. These values were also compared with the physiologic stress limit of the bone. In the zygomatic implant models, the von Mises stress values on both anterior and posterior implants were less than other models under both loading conditions. In addition, the lowest principal stress values were seen in these models. The highest von Mises stress among all models was found to be posterior implants in tilted implant models under oblique loading. In addition, the highest principal stress values were seen at posterior implants in the sinus elevation model under oblique loading. Vertical loading was found to induce less stress than loading at a 30-degree angle. Although zygomatic implants have a more angled placement, the stress values on the bone and implants are lower.