Skip to main content
Top
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Research article

Comparison of stresses in monoblock tilted implants and conventional angled multiunit abutment-implant connection systems in the all-on-four procedure

Authors: Özge Özdal Zincir, Ateş Parlar

Published in: BMC Oral Health | Issue 1/2021

Login to get access

Abstract

Background

The All-on-four dental implant method is an implantology method designed to provide a comfortable prosthetic treatment option by avoiding advanced surgical procedures. This research aims to compare and evaluate the stress and tension values in conventional angled multiunit abutment-implant connection systems and monoblock dental implants used in the all-on-four procedure with finite element analysis.

Methods

Two master models were created by placing four implants connected to multiunit abutments (group A) in the interforaminal region of a completely edentulous mandible and four monoblock implants (group B) in the same region of another completely edentulous mandible. Group A implants were classified according to their diameter as follows: 3.5 mm (M1A), 4.0 mm (M2A), and 4.5 mm (M3A). Similarly, group B implants were classified as M1B, M2B, and M3B. In the six models rehabilitated with acrylic fixed prostheses, a 100 N force was applied to the anterior implant region, and a 250 N force was applied to the posterior cantilever in both axial and 30° oblique directions. Von Mises stresses were analyzed in the bone and implant regions of all models.

Results

M1A and M1B, M2A and M2B, and M3A and M3B were compared with each other under axial and oblique forces. The maximum Von Mises stresses in the bone around implants and the prosthesis screws, and the maximum and minimum principal stresses in the cortical and trabecular bone in group A models were significantly higher than those in group B models.

Conclusions

In monoblock implant systems under axial and oblique forces, higher stress is accumulated in the bone, prosthesis screw and implant compared to multiunit abutment-implant connection systems.
Literature
1.
go back to reference Lee DJ, Saponaro PC. Management of edentulous patients. Dent Clin North Am. 2019;63(2):249–61.CrossRef Lee DJ, Saponaro PC. Management of edentulous patients. Dent Clin North Am. 2019;63(2):249–61.CrossRef
2.
go back to reference Chiapasco M, Zaniboni M. Methods to treat the edentulous posterior maxilla: implants with sinus grafting. J Oral Maxillofac Surg. 2009;67(4):867–71.CrossRef Chiapasco M, Zaniboni M. Methods to treat the edentulous posterior maxilla: implants with sinus grafting. J Oral Maxillofac Surg. 2009;67(4):867–71.CrossRef
3.
go back to reference Bhering CL, Mesquita MF, Kemmoku DT, Noritomi PY, Consani RL, Barao VA. 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. Mater Sci Eng C Mater Biol Appl. 2016;69:715–25.CrossRef Bhering CL, Mesquita MF, Kemmoku DT, Noritomi PY, Consani RL, Barao VA. 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. Mater Sci Eng C Mater Biol Appl. 2016;69:715–25.CrossRef
4.
go back to reference Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol. 2004;75(4):511–6.CrossRef Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol. 2004;75(4):511–6.CrossRef
5.
go back to reference Eliasson A, Palmqvist S, Svenson B, Sondell K. Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants. Int J Oral Maxillofac Implants. 2000;15:505–10.PubMed Eliasson A, Palmqvist S, Svenson B, Sondell K. Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants. Int J Oral Maxillofac Implants. 2000;15:505–10.PubMed
6.
go back to reference Papaspyridakos P, De Souza A, Vazouras K, Gholami H, Pagni S, Weber HP. Survival rates of short dental implants (≤ 6 mm) compared with implants longer than 6 mm in posterior jaw areas: a meta-analysis. Clin Oral Implants Res. 2018;29(Suppl 16):8–20.CrossRef Papaspyridakos P, De Souza A, Vazouras K, Gholami H, Pagni S, Weber HP. Survival rates of short dental implants (≤ 6 mm) compared with implants longer than 6 mm in posterior jaw areas: a meta-analysis. Clin Oral Implants Res. 2018;29(Suppl 16):8–20.CrossRef
7.
go back to reference Saleh Saber F, Ghasemi S, Koodaryan R, Babaloo A, Abolfazli N. The comparison of stress distribution with different implant numbers and inclination angles in all-on-four and conventional methods in maxilla: a finite element analysis. J Dent Res Dent Clin Dent Prospects. 2015;9(4):246–53.CrossRef Saleh Saber F, Ghasemi S, Koodaryan R, Babaloo A, Abolfazli N. The comparison of stress distribution with different implant numbers and inclination angles in all-on-four and conventional methods in maxilla: a finite element analysis. J Dent Res Dent Clin Dent Prospects. 2015;9(4):246–53.CrossRef
8.
go back to reference Tallarico M, Canullo L, Caneva M, Ozcan M. Microbial colonization at the implant-abutment interface and its possible influence on periimplantitis: a systematic review and meta-analysis. J Prosthodont Res. 2017;61:233–41.CrossRef Tallarico M, Canullo L, Caneva M, Ozcan M. Microbial colonization at the implant-abutment interface and its possible influence on periimplantitis: a systematic review and meta-analysis. J Prosthodont Res. 2017;61:233–41.CrossRef
9.
go back to reference Sasada Y, Cochran DL. Implant-abutment connections: a review of biologic consequences and peri-implantitis implications. Int J Oral Maxillofac Implants. 2017;32:1296–307.CrossRef Sasada Y, Cochran DL. Implant-abutment connections: a review of biologic consequences and peri-implantitis implications. Int J Oral Maxillofac Implants. 2017;32:1296–307.CrossRef
10.
go back to reference Liaw K, Delfini RH, Abrahams JJ. Dental implant complications. Semin Ultrasound CT MR. 2015;36(5):427–33.CrossRef Liaw K, Delfini RH, Abrahams JJ. Dental implant complications. Semin Ultrasound CT MR. 2015;36(5):427–33.CrossRef
11.
go back to reference Özdal Zincir Ö, Karapinar G, Ünür M, Katiboğlu AB. How do differences of dental implants’ internal connection systems affect stress distribution? A 3-dimensional finite element analysis. Balk J Dent Med. 2019;23:126–31.CrossRef Özdal Zincir Ö, Karapinar G, Ünür M, Katiboğlu AB. How do differences of dental implants’ internal connection systems affect stress distribution? A 3-dimensional finite element analysis. Balk J Dent Med. 2019;23:126–31.CrossRef
12.
go back to reference van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage. Clin Oral Implants Res. 2002;13(6):617–22.CrossRef van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage. Clin Oral Implants Res. 2002;13(6):617–22.CrossRef
13.
go back to reference Ellakwa A, Raj T, Deeb S, Ronaghi G, Martin FE, Klineberg I. Influence of implant abutment angulations on the fracture resistance of overlaying CAM-milled zirconia single crowns. Aust Dent J. 2011;56:132–40.CrossRef Ellakwa A, Raj T, Deeb S, Ronaghi G, Martin FE, Klineberg I. Influence of implant abutment angulations on the fracture resistance of overlaying CAM-milled zirconia single crowns. Aust Dent J. 2011;56:132–40.CrossRef
14.
go back to reference Rismanchian M, Hatami M, Badrian H, Khalighinejad N, Goroohi H. Evaluation of microgap size and microbial leakage in the connection area of 4 abutments with Straumann (ITI) implant. J Oral Implantol. 2012;38(6):677–85.CrossRef Rismanchian M, Hatami M, Badrian H, Khalighinejad N, Goroohi H. Evaluation of microgap size and microbial leakage in the connection area of 4 abutments with Straumann (ITI) implant. J Oral Implantol. 2012;38(6):677–85.CrossRef
15.
go back to reference Simon RL. Single implant-supported molar and premolar crowns: a ten-year retrospective clinical report. J Prosthet Dent. 2003;90:517–21.CrossRef Simon RL. Single implant-supported molar and premolar crowns: a ten-year retrospective clinical report. J Prosthet Dent. 2003;90:517–21.CrossRef
16.
go back to reference Mishra SK, Chowdhary R, Kumari S. Microleakage at the different implant abutment interface: a systematic review. J Clin Diagn Res. 2017;11(6):ZE10–5.PubMedPubMedCentral Mishra SK, Chowdhary R, Kumari S. Microleakage at the different implant abutment interface: a systematic review. J Clin Diagn Res. 2017;11(6):ZE10–5.PubMedPubMedCentral
17.
go back to reference Correa S, Ivancik J, Isaza JF, Naranjo M. Evaluation of the structural behavior of three and four implant-supported fixed prosthetic restorations by finite element analysis. J Prosthodont Res. 2012;56(2):110–9.CrossRef Correa S, Ivancik J, Isaza JF, Naranjo M. Evaluation of the structural behavior of three and four implant-supported fixed prosthetic restorations by finite element analysis. J Prosthodont Res. 2012;56(2):110–9.CrossRef
18.
go back to reference Bellini CM, Romeo D, Galbusera F, et al. Comparison of tilted versus nontilted implant-supported prosthetic designs for the restora-tion of the edentulous mandible: a biomechanical study. Int J Oral Maxillofac Implants. 2009;24:511–7.PubMed Bellini CM, Romeo D, Galbusera F, et al. Comparison of tilted versus nontilted implant-supported prosthetic designs for the restora-tion of the edentulous mandible: a biomechanical study. Int J Oral Maxillofac Implants. 2009;24:511–7.PubMed
19.
go back to reference Malhotra AO, Padmanabhan TV, Mohamed K, Natarajan S, Elavia U. Load transfer in tilted implants with varying cantilever lengths in an all-on-four situation. Aust Dent J. 2012;57(4):440–5.CrossRef Malhotra AO, Padmanabhan TV, Mohamed K, Natarajan S, Elavia U. Load transfer in tilted implants with varying cantilever lengths in an all-on-four situation. Aust Dent J. 2012;57(4):440–5.CrossRef
20.
go back to reference Eazhil R, Swaminathan SV, Gunaseelan M, Kannan GV, Alagesan C. Impact of implant diameter and length on stress distribution in osseointegrated implants: a 3D FEA study. J Int Soc Prev Community Dent. 2016;6(6):590–6.CrossRef Eazhil R, Swaminathan SV, Gunaseelan M, Kannan GV, Alagesan C. Impact of implant diameter and length on stress distribution in osseointegrated implants: a 3D FEA study. J Int Soc Prev Community Dent. 2016;6(6):590–6.CrossRef
21.
go back to reference Kilic E, Doganay O. Evaluation of stress in tilted implant concept with variable diameters in the atrophic mandible: three-dimensional finite element analysis. J Oral Implantol. 2020;46(1):19–26.PubMed Kilic E, Doganay O. Evaluation of stress in tilted implant concept with variable diameters in the atrophic mandible: three-dimensional finite element analysis. J Oral Implantol. 2020;46(1):19–26.PubMed
22.
go back to reference Robau-Porrua A, Pérez-Rodríguez Y, Soris-Rodríguez LM, Pérez-Acosta O, González JE. The effect of diameter, length and elastic modulus of a dental implant on stress and strain levels in peri-implant bone: a 3D finite element analysis. Biomed Mater Eng. 2020;30:541–58.PubMed Robau-Porrua A, Pérez-Rodríguez Y, Soris-Rodríguez LM, Pérez-Acosta O, González JE. The effect of diameter, length and elastic modulus of a dental implant on stress and strain levels in peri-implant bone: a 3D finite element analysis. Biomed Mater Eng. 2020;30:541–58.PubMed
23.
go back to reference Huang Y, Wang J. Mechanism of and factors associated with the loosening of the implant abutment screw: a review. J Esthet Restor Dent. 2019;31(4):338–45.CrossRef Huang Y, Wang J. Mechanism of and factors associated with the loosening of the implant abutment screw: a review. J Esthet Restor Dent. 2019;31(4):338–45.CrossRef
24.
go back to reference Oh JH, Kim YS, Lim JY, Choi BH. Stress distribution on the prosthetic screws in the all-on-4 concept: a three-dimensional finite element analysis. J Oral Implantol. 2020;46(1):3–12.CrossRef Oh JH, Kim YS, Lim JY, Choi BH. Stress distribution on the prosthetic screws in the all-on-4 concept: a three-dimensional finite element analysis. J Oral Implantol. 2020;46(1):3–12.CrossRef
25.
go back to reference AlHomidhi M, Alqahtani F. Evaluation of fracture load of cement-, screw-, and multiscrew-retained abutments for implant-supported fixed partial dentures. Int J Oral Maxillofac Implants. 2021;36(1):55–8.CrossRef AlHomidhi M, Alqahtani F. Evaluation of fracture load of cement-, screw-, and multiscrew-retained abutments for implant-supported fixed partial dentures. Int J Oral Maxillofac Implants. 2021;36(1):55–8.CrossRef
26.
go back to reference Moraes SLD, Verri FR, Santiago JF Jr, Almeida DAF, Lemos CAA, Gomes JML, et al. Three-dimensional finite element analysis of varying diameter and connection type in implants with high crown-implant ratio. Braz Dent J. 2018;29(1):36–42.CrossRef Moraes SLD, Verri FR, Santiago JF Jr, Almeida DAF, Lemos CAA, Gomes JML, et al. Three-dimensional finite element analysis of varying diameter and connection type in implants with high crown-implant ratio. Braz Dent J. 2018;29(1):36–42.CrossRef
27.
go back to reference Raaj G, Manimaran P, Kumar CD, Sadan DS, Abirami M. Comparative evaluation of implant designs: influence of diameter, length, and taper on stress and strain in the mandibular segment-a three-dimensional finite element analysis. J Pharm Bioallied Sci. 2019;11(Suppl 2):S347–54.PubMedPubMedCentral Raaj G, Manimaran P, Kumar CD, Sadan DS, Abirami M. Comparative evaluation of implant designs: influence of diameter, length, and taper on stress and strain in the mandibular segment-a three-dimensional finite element analysis. J Pharm Bioallied Sci. 2019;11(Suppl 2):S347–54.PubMedPubMedCentral
Metadata
Title
Comparison of stresses in monoblock tilted implants and conventional angled multiunit abutment-implant connection systems in the all-on-four procedure
Authors
Özge Özdal Zincir
Ateş Parlar
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-02023-y

Other articles of this Issue 1/2021

BMC Oral Health 1/2021 Go to the issue