title: The influence of cantilever length and implant inclination on stress distribution in maxillary implant-supported fixed dentures.
abstract: BACKGROUND
  The benefits and limitations of jaw treatments with tilted versus vertical implants, as well as prosthesis design with and without posterior cantilevers, have been extensively discussed. However, biomechanical advantages associated with cantilevers in fixed dentures (FDs) and tilted implants in the maxillae are less well documented.
  
  
  OBJECTIVE
  The purpose of this study was to compare and analyze, via 3-dimensional (3-D) finite element analysis, stresses transmitted to tilted versus vertical implants and the surrounding periimplant bone in the maxillae.
  
  
  METHODS
  A 3-D edentulous maxillary model was created using customized computer software (FEMAP 8.3). Four implants were virtually placed in the premaxilla and splinted with an FD. Keeping the prosthesis length constant, 4 different configurations were evaluated with the distal implants inclined 0, 15, 30, and 45 degrees; cantilever extensions were 13, 9, 5, and 0 mm, respectively. A vertical load (150 N) was applied to the distal portion of the posterior cantilevers. Von Mises' stress values transmitted to periimplant bone and at the metal framework of FDs on implants were evaluated in cancellous and cortical bone.
  
  
  RESULTS
  The maximum stresses recorded in periimplant bone for the vertical implants were 75.0 MPa (distal implants), 35.0 MPa (mesial implants), and 95.0 MPa for the metal frameworks. Tilted distal implants, with consequent reduction of the posterior cantilevers, resulted in decreased stress values for all of the variables: -12.9%, -18.3%, and -11.5% for the 15-degree configuration; -47.5%, -52.6%, and -31.3% for the 30-degree configuration; and -73.5%, -77.7%, and -85.6% for the 45-degree configuration
  
  
  CONCLUSIONS
  Finite element analysis data regarding rehabilitation of atrophic maxillae revealed that tilted distal implants, rigidly splinted with an FD, decrease stress in the periimplant bone and frameworks. This treatment modality seems to be a valid therapeutic alternative to conventional maxillary fixed complete prostheses supported by vertical dental implants with posterior cantilevers.
authors.affiliation: Department of Prosthetic Dentistry, University of Genoa, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bevilacqua
authors.forename: Tiziano
authors.initials: T
authors.lastname: Tealdo
authors.forename: Maria
authors.initials: M
authors.lastname: Menini
authors.forename: Francesco
authors.initials: F
authors.lastname: Pera
authors.forename: Alexei
authors.initials: A
authors.lastname: Mossolov
authors.forename: Carl
authors.initials: C
authors.lastname: Drago
authors.forename: Paolo
authors.initials: P
authors.lastname: Pera
mesh_terms: D001696:Biomechanical Phenomena; D003198:Computer Simulation; D003722:Dental Alloys / Q000737:chemistry; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D003779:Denture Design; D003827:Denture, Complete, Upper; D055119:Elastic Modulus; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007575:Jaw, Edentulous / Q000503:physiopathology; D008437:Maxilla / Q000502:physiology*; D008954:Models, Biological; D012984:Software; D013314:Stress, Mechanical; D014584:User-Computer Interface
chemical_list: D003722:Dental Alloys; D015921:Dental Implants