Role of implant configurations supporting three-unit fixed partial denture on mandibular bone response: biological-data-based finite element study.

Abstract

Implant-supported fixed partial denture with cantilever extension can transfer the excessive load to the bone around implants and stress/strain concentration potentially leading to bone resorption. This study investigated the effects of implant configurations supporting three-unit fixed partial denture (FPD) on the stress and strain distribution in the peri-implant bone by combining clinically measured time-dependent loading data and finite element (FE) analysis. A 3-dimensional mandibular model was constructed based on computed tomography (CT) images. Four different configurations of implants supporting 3-unit FPDs, namely three implant-supported FPD, conventional three-unit bridge FPD, distal cantilever FPD and mesial cantilever FPD, were modelled. The FPDs were virtually inserted to the molar area in the mandibular FE models. The FPDs were loaded according to time-dependent in vivo-measured 3-dimensional loading data during chewing. The von Mises stress (VMS) and equivalent strain (EQS) in peri-implant bone regions were evaluated as mechanical stimuli. During the chewing cycles, the regions near implant necks and bottom apexes experienced high VMS and EQS than the middle regions in all implant-supported FPD configurations. Higher VMS and EQS values were also observed at the implant neck region adjacent to the cantilever extension in the cantilevered configurations. The patient-specific dynamic loading data and CT-based reconstruction of full 3D mandibular allowed us to model the biomechanical responses more realistically. The results provided data for clinical assessment of implant configuration to improve longevity and reliability of the implant-supported FPD restoration.