title: Influence of implant framework and mandibular flexure on the strain distribution on a Kennedy class II mandible restored with a long-span implant fixed restoration: a pilot study.
abstract: BACKGROUND
  The human mandible flexes during different jaw movements. Mandibular flexure is known to be restricted when natural dentition is restored with long-span fixed prostheses, but its effect on implant-supported fixed prostheses is unknown. Restriction of mandibular movement by implant-supported fixed prostheses may lead to excess strain accumulation, which could affect the outcome of implant treatment.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the influence of mandibular flexure on the implant bone interface by measuring the strain distribution in the body of the mandible at the periimplant level and at the implant framework level during the unilateral loading of a long-span implant-supported fixed prosthesis.
  
  
  METHODS
  A partially edentulous mandible model with the mandibular left premolars and molars missing was fabricated in epoxy resin. Two implants were placed in the edentulous area, one in the position of the first premolar and one in the position of the second molar. Strain gauges were cemented at the implant bone interface parallel to each implant on the body of the mandible and on the framework. Three screw-retained, 3 × 3-mm bar-shaped frameworks were cast from cobalt-chromium alloy. The fit of these frameworks was deemed clinically acceptable with a routine clinical assessment technique. The mandible model was suspended by elastic cords to a universal testing machine. A 50-N load cell was placed on the occlusal surface of the right first molar. The mandible model was then loaded to 50 N on the working side first without any framework and then a second time with the framework in place. Information from the strain gauges were collected with a computer for analysis.
  
  
  RESULTS
  When the mandible model was loaded without the implant framework, the buccal aspect of the body of the mandible experienced mainly compression, whereas the lingual aspect was mainly in tension on the working side under unilateral loading. At the implant-bone interface, compression strain was detected on the mesial aspect of the mesial implant. When frameworks were placed and a unilateral load applied, compression was detected on the mesial and buccal aspect of the mesial implant with all 3 frameworks. The amount of strain recorded was higher than that recorded without any framework in place.
  
  
  CONCLUSIONS
  Mandibular flexure occurred during unilateral loading. The amount of strain transmitted to the implants increased with the screw-retained fixed-implant frameworks in place. The amount of strain introduced by mandibular flexure under unilateral loading may not be enough to stimulate bone remodeling; however, the accumulative strain generated by mandibular flexure under cyclic loading and its relationship with bone remodeling is unclear.
authors.affiliation: Private practice, Otago, New Zealand.
authors.forename: Constance
authors.initials: C
authors.lastname: Law
authors.affiliation: Senior Lecturer, Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Otago, New Zealand. Electronic address: vincent.bennani@stonebow.otago.ac.nz.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bennani
authors.affiliation: Professor, Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Otago, New Zealand.
authors.forename: Karl
authors.initials: K
authors.lastname: Lyons
authors.affiliation: Professor, Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Otago, New Zealand.
authors.forename: Mike
authors.initials: M
authors.lastname: Swain
mesh_terms: D001641:Bicuspid; D001696:Biomechanical Phenomena; D001732:Bite Force; D002858:Chromium Alloys / Q000737:chemistry; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D019094:Dental Prosthesis, Implant-Supported; D003779:Denture Design; D003830:Denture, Partial, Fixed; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000503:physiopathology / Q000534:rehabilitation*; D008334:Mandible / Q000503:physiopathology*; D008953:Models, Anatomic; D008963:Molar; D016348:Osseointegration / Q000502:physiology; D010865:Pilot Projects; D018583:Pliability; D013314:Stress, Mechanical; D014025:Titanium / Q000737:chemistry
chemical_list: D002858:Chromium Alloys; D015921:Dental Implants; D003764:Dental Materials; D014025:Titanium