Biomechanical finite element analysis of short-implant-supported, 3-unit, fixed CAD/CAM prostheses in the posterior mandible

OBJECTIVE: To assess the biomechanical effects of different prosthetic/implant configurations and load directions on 3-unit fixed prostheses supported by short dental implants in the posterior mandible using validated 3-D finite element (FE) models. METHODS: Models represented an atrophic mandible, missing the 2nd premolar, 1st and 2nd molars, and rehabilitated with either two short implants (implant length-IL = 8 mm and 4 mm) supporting a 3-unit dental bridge or three short implants (IL = 8 mm, 6 mm and 4 mm) supporting zirconia prosthesis in splinted or single crowns design. Load simulations were performed in ABAQUS (Dassault Systèmes, France) under axial and oblique (30°) force of 100 N to assess the global stiffness and forces within the implant prosthesis. Local stresses within implant/prosthesis system and strain energy density (SED) within surrounding bone were determined and compared between configurations. RESULTS: The global stiffness was around 1.5 times higher in splinted configurations vs. single crowns, whereby off-axis loading lead to a decrease of 39%. Splinted prostheses exhibited a better stress distribution than single crowns. Local stresses were larger and distributed over a larger area under oblique loads compared to axial load direction. The forces on each implant in the 2-implant-splinted configurations increased by 25% compared to splinted crowns on 3 implants. Loading of un-splinted configurations resulted in increased local SED magnitude. CONCLUSION: Splinting of adjacent short implants in posterior mandible by the prosthetic restoration has a profound effect on the magnitude and distribution of the local stress peaks in peri-implant regions. Replacing each missing tooth with an implant is recommended, whenever bone supply and costs permit.