JIOH on LinkedIn JIOH on Facebook
  • Users Online: 424
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 413-419

Biomechanical stress in removable complete dental prostheses: A narrative review of finite element studies


1 Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakakah, Jouf Province, Saudi Arabia; Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
2 Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
3 Department of Clinical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, United States

Date of Submission17-May-2020
Date of Decision20-Aug-2020
Date of Acceptance20-Aug-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Dr. Nafij Jamayet
Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan.
Malaysia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_190_20

Rights and Permissions
  Abstract 

Aim: This review aimed to investigate the stress that arises in the conventional and implant-assisted removable complete dental prostheses (RCDPs) and supporting structures. Materials and Methods: A literature survey was conducted for the full-text English articles which only used finite element analysis to examine the stress developed in the conventional and implant-assisted RCDPs from January 2000 to May 2020. Results: In total, 1789 articles were included in the survey. Of the 1789 articles obtained, 1746 were excluded based on initial screening of the title and abstract. Finally, 24 articles were recruited for this study after excluding the duplicated articles with the same results. The significant findings and conclusions were extracted and grouped under biomechanical stress developed in complete dental prostheses, how to manage the stress developed in conventional RCDPs, and the factors affecting the development of stress in implant-assisted RCDPs. Conclusion: The RCDPs subject to different kinds of stress in the form of compressive and tensile strengths. The buccal flanges exhibit compressive strains responding to the vertical forces while labial flanges show the same type of strain responding to all force directions. The highest tensile strain concentration exists at the anterior frenum, midline, and buccal flanges when the forces were horizontal. Whilst, retention and support in implant-assisted prostheses are exceptionally improved, the implants and prostheses are subjected to stress which may result in failure of these kinds of prosthesis. This stress can be managed by increasing the number and size and by decreasing the angulation of the implants, using splinted or short collar unsplinted abutments, reinforcing the denture base, and using canine guidance occlusion.

Keywords: Complete denture, Finite element analysis, Implant-assisted removable prosthesis


How to cite this article:
Mousa MA, Jamayet N, Lynch E, Husein A. Biomechanical stress in removable complete dental prostheses: A narrative review of finite element studies. J Int Oral Health 2020;12:413-9

How to cite this URL:
Mousa MA, Jamayet N, Lynch E, Husein A. Biomechanical stress in removable complete dental prostheses: A narrative review of finite element studies. J Int Oral Health [serial online] 2020 [cited 2020 Nov 25];12:413-9. Available from: https://www.jioh.org/text.asp?2020/12/5/413/298789




  Introduction Top


Removable dental prostheses (RDPs) have been considered an acceptable cost-effective treatment option to restore aesthetic, masticatory efficiency and maintain the rest of the dentition in partially and completely edentulous patients.[1],[2],[3] The polymethylmethacrylate (PMMA) is still the material of choice for denture fabrication due to its pleasing appearance and easily laboratory steps. However, due to the poor flexural strength and low fatigue resistance, the frequent fracture of PMMA resin base RDPs is frequent problem.[4] Moreover, the supporting structures of the prosthesis subject to stress during function causing bone resorption and periodontal loss around the abutments or bone loss around implants which, accordingly, can lead to failure of the prostheses.[5],[6]

The implant-assisted removable complete dental prostheses (RCDPs) show many advantages comparing with the conventional one.[7],[8],[9] There is a direct relationship between success in dental treatment and biomechanics of materials used in dentistry. The study of stress in the teeth and associated structures under RDPs has been reported with different methods such as photoelasticity, strain-gauge measurement, brittle laquer, and finite element analysis (FEA). FEA provide noninvasive reproducible qualitative and quantitative information of biomechanical characteristics of dental prostheses and supporting structures with no need for ethical considerations.[10],[11] FEA is carried out through constructing a finite element (FE) model(s), followed by specifying the materials’ property, loading, and boundary conditions for accurate simulation. With the advancement of digital imaging systems, FEA can be done to human bodies through exporting the data of geometry and properties of the bone, in three-dimensions (3D), from cone beam computerized tomography or magnetic resonance imaging to the FE model, thus an accurate anatomical model can be created.[11],[12],[13]

The FEA studies of biomechanical stress developed in RDPs is a rapidly expanding, but still the one that has not yet received broad review in the dental literature. The purpose of this narrative review was to appraise the stress developed in RCDPs and supporting structures using FEA.


  Materials and Methods Top


Search strategy

This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[14] The research focused question was identified with the aid of the PICO format: (P) is for the Participants, (I) for the Intervention, (C) for the Comparison and (O) for the Outcome.[15] (P) was the studies that only used FEA to identify the distribution of stress, the intervention (I) was the removable complete dental prostheses, the comparison (C) was the conventional and implant-assisted RCDPs fabricated using different protocols or materials, and the outcome (O) was the distribution of the stress in implants and overlying prostheses.

Information sources

An electronic search was conducted in the Google Scholar, PubMed, Scopus, Web of Science and Saudi Dental Library databases. The keywords were finite element analysis, conventional and or implant-assisted removable complete denture prostheses, biomechanical stress, stress distribution, and deflection of the prostheses. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis. The research was done to find answers for three questions. The first question was “where the biomechanical stress distributed in the prostheses and supporting structures?”, the second question was “What is the factors affecting the management of the biomechanical stress in RCDPs?,” and the third question was “ What is factors affecting the management of biomechanical stress in implant-assisted RCDPs?” A survey of the literature was conducted for the full-text English articles from January 2000 to May 2020 which only used FEA to examine the stress developed in the RCDPs.

Inclusion criteria

Eligibility criteria were as follows:

  • All the studies that used FEA to analyze the stress developed only in complete dental prostheses


  • The studies only conducted to manage the stress in complete dental prostheses, and


  • The studies conducted to identify the stress in implant-assisted RCDPs


  • The studies between 2000 and 2020


  • Exclusion criteria

    Exclusion criteria were as follows:

  • The clinical studies


  • The studies that used methods other than FEA


  • The studies before 2000


  • The studies conducted on fixed, removable partial, or maxillofacial prosthetic restoration



  •   Results Top


    During the selected times, 1789 articles were included in the survey. Out of the 1789 articles obtained, 1746 were excluded based on initial screening of the title and abstract as they did not relevant to the objectives of the present review. Finally, 24 articles were recruited for this study after excluding the old articles with the same results of the new updated articles. Due to heterogenicity of the results, a narrative review was designed rather than meta-analysis review. To be convenient to the readers, the significant findings and conclusions were extracted and grouped under biomechanical stress developed in complete dental prostheses, how to manage the stress developed in conventional RCDPs, and the factors affecting the development of stress in implant-assisted RCDPs. For answering the first question of distribution of biomechanical stress developed in complete denture prostheses, three articles were included after excluding the other factors such as partial maxillofacial, fixed, and non-FEA studies.[16],[17],[18] For answering the second question of the factors affecting the management of biomechanical stress developed in RCDPs, five articles were picked after exclusion of the irrelevant articles.[19],[20],[21],[22],[23] Finally, for the factors affecting the management of the stress developed in the implant-assisted RCDPs, 16 articles were finally chosen after exclusion of the articles with duplicate results and irrelevant [Figure 1].[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39]
    Figure 1: Flow chart for the search process indicating numbers (n) of included and excluded studies

    Click here to view



      Discussion Top


    Besides the materials of the prostheses and hard tissue structures, FEA has proven to provide a noninvasive methodology in identifying the biomechanical behavior of oral mucosa and RDPs.[10]

    Biomechanical stress in removable complete dental prostheses

    The residual ridge and overlying mucosa play a major role in the support and retention of conventional, tooth, and implant-assisted RDPs.[8] The thickness of mucosa, denture adaptation, arrangement of artificial teeth, and amount and direction of occlusal forces can influence the load transmitted to supporting structures.[2],[3],[6] The healthy mucosa acts as a cushion to prevent the transmission of an excessive load to the supporting structures, that cause inflammation of the mucosa and resorption of the residual ridge in different ways. Regarding bearing and limiting structures of the RCDPs, it was found that the highest tensile strain is concentrated around the anterior notch, midline, and buccal flanges when the forces were horizontal. This can help explain the frequent fracture of dentures at these points. The buccal flanges exhibit compressive strains responding to the vertical forces while labial flanges show the same type of strain responding to all force directions.[5],[16] With respect to the lower complete denture, the highest stress due to vertical forces was mainly concentrated on the retro-molar pad and the inclined plane of posterior alveolar ridge. When horizontal and lateral forces are applied, the main forces are compressive and are mainly concentrated on the anterior lingual alveolus which, accordingly, shows a greater tendency to resorption.[17] Loss of denture stability leads to inadequate occlusal force distribution due to denture movement around a fulcrum line. An adequate buccolingual position of posterior teeth is crucial not only to prevent denture instability but also to decrease the excessive forces transmitted to underlying structures. Both balanced and lingualized occlusions transmit minimal pressure at the mid-palatal suture area, whilst the crest of the ridge receives the main stress concentration. During excursive movement, the working side in balanced occlusion scheme produce a greater pressure than the balancing side, whilst in the lingualized occlusion scheme the vice versa occurs.[18]

    Management of stress in RCDPs and supporting structures

    To overcome the mechanical weaknesses of the PMMA resin of denture base materials and to decrease the stress on the supporting structures, a variety of different approaches have been developed.

    Modifications in denture base materials approach

    One of these approaches is using alternative materials such as nylon, polystyrene, and polycarbonate. Another approach involves reinforcing the PMMA resin by adding fibrous reinforcing materials such as carbon, glass, and high-performance polyethylene.[19] A significant improvement in denture strength with high-performance polyethylene fibers compared to conventional acrylic denture base materials was reported. Adding 5% Kevlar fibers and 3% ZrO2 particles were also found to decrease the deformation of the acrylic denture base compared with a conventional one.[20]

    The type and thickness of teeth material have a great influence on fracture resistance of the denture base. The fracture resistance of the denture base was higher with composite resin teeth compared to acrylic or ceramic materials. However, this resistance is declined as the thickness of the composite resin teeth increases.[21]

    Adding soft liners was found to reduce the stress concentration on the denture supporting structures and decrease the probability of fracture of RCDPs provided the elasticity of soft liners should ideally match that of mucosa. The maximum stress in the mucosa and minimum stress in the bone decrease when the thickness of the relined material is increased to 2 mm.[22]

    Occlusal modification concept

    Complete dentures with zero-degree artificial teeth show a low magnitude of elaborated stress in supporting structures when compared with the stress observed in teeth with cusp angle of 33° and 20°.[23]

    Using overdenture concepts

    Teeth and implant-assisted RCDPs are considered a great option when compared to conventional RCDPs because they act not only to improve retention and stability of prostheses, but they also help preserve the residual ridge.[40] However, the stress developed in bone is increased in implant-assisted RCDPs when compared with conventional dentures. This attributed to the integrated implant and associated attachment systems receive the loads to prevent movement of prostheses. This stress may induce mechanical failures in prostheses, failures in osseointegration, or even implant fractures.

    Factors affecting stress developed in implant-assisted RCDPs

    Implant–bone interface and bone quality

    The bone of a higher density was found provide a better environment for implants compared to the bone with a low density. The presence of cortical bone contacting the implants, even when a bone defect is present, improves the biomechanical performance of implants in comparison with contact with only trabecular bone. The cancellous bone of a higher density also provides a better biomechanical environment for implants compared to the cancellous bone with a low density. The highest stress occurs around trabecular bone around implant-neck, whilst the least stress was recorded at the trabecular bone around the apical regions.[24],[25] The bone loss surrounding implants increases the stress concentration in implant fixture. The highest stress occurs around trabecular bone around implant–neck, whilst the least stress was recorded at the trabecular bone around the apical regions.[26] The stability of the implant–bone interfaces plays a major role in the longevity and success of these prostheses. Although implant-assisted RCDPs are associated with a decrease in the load to the underlying structures, they lead to development of stress in the overlying prostheses, especially at the areas around the implant prostheses connections.[27]

    Number and location of implants

    The stress developed at the bone–implant interface in implant-assisted RCDPs is inversely proportional to the number of implants. As the number of implants increases, the amount of developing stress under prostheses and in implant–bone interfaces is decreased.[28]

    The influence of the location of implants on biomechanical stress is controversial. In some studies, the more anterior placement of the implant, such as in the lateral incisor area, the least stress in the peri-implant–bone interface is recorded.[29] This is explained with the greater length of the lever arm and increase in the bending moment in the case of implants in premolar areas. In contrary of that, other studies did not recommend the positioning of the implants in lateral incisors area from biomechanical point of view and instead of that those authors recommended positioning the implants in the premolars area.[30]

    Implant angulation

    The implant angulation can affect the stress at implant–bone interface. The inclined implants, even with small changes in inclination, cause higher stresses in the peri-implant–bone than implants placed parallel to the long axis. The greatest stress value in the implant–bone interface was recorded around, in order, distally inclined implant, then lingually inclined, then mesially inclined, whilst the least stress was recorded in the implant with buccal directions.[29] The stress caused by inclined implants aggravates the resorption in cortical and cancellous bones leading to implant failure.

    Length, diameter, and size of implant

    A wide, tapered, and long implant is the most favorable choice to minimize the stress at the implant–bone interface within implant-assisted RCDPs comparing the narrow, short and tapered implants that increase the stress, especially in the bone with low density. The narrow, short taper implants were found to increase the strain in the implant–bone interfaces, especially in bone with low density.[24]

    Zygomatic implants have proven to provide high success rate in the management of severely resorbed maxillae.[31] The exteriorized and extra-maxillary types are the most used types of zygomatic implants as they are placed external to the maxillary sinus and can help prevent possible development of sinusitis. The exteriorized technique provides more favorable stress distribution on the micro-unit screws and bone tissues. However, because of their length, they are subjected to stress and deformation of the surrounding bone. Adding two implants around the lateral incisor space provides adequate stress distribution and minimizes the stress on these implants.[31]

    Splinting and attachment system

    There are different types of attachment systems usually used in implant-assisted RCDPs such as the ball and socket (O-ring attachment), bar-clips (splinted), magnetic system, and implant locator attachments. The stress developed within the supporting structures of implant-assisted RCDPs is affected by the type of implant system. The prostheses retained with bar and clips attachment system, in case of two-implant-assisted mandibular RCDPs are associated with less stress in the supporting tissues when compared with other types of attachments. Moreover, they provide more favorable stress distribution to the implant–bone interface during lateral and protrusive movements when compared with ball attachments although there were no pathological changes recorded with both types.[32] This was interpreted by the continuous rotation of the denture around a fulcrum line passing the nonsplinted implant. However, the locator attachment was found more preferred when used with four-implant-assisted RCDPs in terms of reduction in the stresses in the peri-implant bone tissue, mucosa and implant/prosthetic components,[33] or when compared with bar-clips with cantilever.[34] The use of bar-clip attachment system with distally placed O-ring attachment design found optimized the distribution of the maximum stress within prostheses and implants.[34],[35] Comparing other types of nonsplinted implants, the locator attachments show less and more homogenous stress distribution compared with ball attachments.[36] This is mainly due to high modulus of elasticity, metal-to-metal contact of O-ring attachments which leads to the transfer of the occlusal forces directly to the body of the implants, resulting in higher stresses at the implant–bone interfaces.

    The magnetic attachment systems have three major different commercial forms, including the flat, dome, and cushion shapes. Comparing all types, the cushion and dome types are considered better choices rather than the flat types.[37] This is mainly due to the rigidity of the flat type which is higher than the dome and cushion types. The rigidity of attachments is inversely proportional to the load on the bearing structures and directly proportional to the stress at the implant–bone interfaces. The more resilient the attachment, the more load on the denture bearing structure and less load on the implant.[34]

    The height of the attachment was found to affect the stress developed within the implant–bone interface. As the height of an attachment shortens, the stress in the prosthesis will be lower, especially when it placed parallel to the long axis of an implant.[29],[38]

    Thickness of the mucosa

    The relieving effect of different thicknesses of mucosa beneath conventional and implant-assisted RCDPs has been established. As the thickness of mucosa increases, the stress under RCDPs and implant–bone interfaces decrease, whilst the stress around the attachments increases. This relieving effect leads to lowering bone tissue deformations.[35]

    Occlusion

    Bilateral balanced occlusion is considered a basic requirement for denture stability. However, a variety of occlusion concepts have been developed in conventional and implant-assisted RCDPs to ensure functional and aesthetic efficiency and to provide an even distribution of the occlusal load to supporting structures. The linear occlusion develops high stress in the implant, attachment system, and prosthesis compared to the lingualized occlusion scheme. Comparing different occlusal schemes, the lowest stress value is observed with the canine-guided occlusion in different loading conditions, whilst the highest stress value is recorded with the monoplane occlusion.[39]


      Conclusion Top


    The removable complete dental prostheses and bearing structures are subjected to stress during function which may induce bone resorption and/or failure in the prostheses. The stress is more concentrated in midline and labial notch. In implant-assisted RCDPs, although the displacement of the prostheses decreases, there is stress developed in implants, implant–bone interface and the overlying prostheses depending on the thickness, type of denture materials, and the types of occlusion. This developed stress can be controlled by controlling the loading conditions, increasing the number and size, and decreasing the angulation of the implants, using metal frameworks or fiber-inforced acrylic base and using canine-guided occlusion.

    Future scope

    Although the FEA has been extensively used in assessment of the stress on different kinds of prosthetic restoration, there is still shortage in estimation of stress in different kinds of palatal and ridge shape, using narrow implant diameter and different kinds of base materials used in denture using FEA.

    Acknowledgment

    Nil

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

    Authors contribution

    MA Mousa: Data collection, writing, and structuring the manuscript, N Jamayet: Data collection, E Lynch: revising the final manuscript, A Husien: revising the data and revising the final manuscript.

    Ethical policy and institutional review board statement

    Not applicable.

    Declaration of patient consent

    Not applicable.

    Data availability statement

    The data set presented within this manuscript has been obtained from 42 original articles. The data already available within the articles.



     
      References Top

    1.
    Assunção WG, Barão VA, Delben JA, Gomes EA, Tabata LF A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: A literature review. Gerodontology 2010;27:154-62.  Back to cited text no. 1
        
    2.
    Mousa MA, Lynch E, Sghaireen MG, Zwiri AM, Baraka OA Influence of time and different tooth widths on masticatory efficiency and muscular activity in bilateral free-end saddles. Int Dent J 2017;67:29-37.  Back to cited text no. 2
        
    3.
    Mousa MA, Patil S, Lynch E Masticatory efficiency and muscular activity in removable partial dental prostheses with different cusp angles. J Prosthet Dent 2017;117:55-60.  Back to cited text no. 3
        
    4.
    Pfeiffer P, Rolleke C, Sherif L Flexural strength and moduli of hypoallergenic denture base materials. J Prosthet Dent 2005;93:372-7.  Back to cited text no. 4
        
    5.
    Cheng YY, Cheung WL, Chow TW Strain analysis of maxillary complete denture with three-dimensional finite element method. J Prosthet Dent 2010;103:309-18.  Back to cited text no. 5
        
    6.
    Chen J, Ahmad R, Li W, Swain M, Li Q Biomechanics of oral mucosa. J R Soc Interface 2015;12:20150325.  Back to cited text no. 6
        
    7.
    Montero J, Castillo-Oyagüe R, Lynch CD, Albaladejo A, Castaño A Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study. J Dent 2013;41:493-503.  Back to cited text no. 7
        
    8.
    Mousa MA, Baraka OA Masticatory efficiency of tooth supported overdenture wearers with different platform lengths. Indian J Stomat 2016;7:4-8.  Back to cited text no. 8
        
    9.
    Sghaireen MG, Srivastava KC, Shrivastava D, Ganji KK, Patil SR, Abuonq A, et al. A CBCT based three-dimensional assessment of mandibular posterior region for evaluating the possibility of bypassing the inferior alveolar nerve while placing dental implants. Diagnostics 2020;10:406.  Back to cited text no. 9
        
    10.
    Wang G, Zhang S, Bian C, Kong H Verification of finite element analysis of fixed partial denture with in vitro electronic strain measurement. J Prosthodont Res 2016;60:29-35.  Back to cited text no. 10
        
    11.
    Trivedi S Finite element analysis: A boon to dentistry. J Oral Biol Craniofac Res 2014;4:200-3.  Back to cited text no. 11
        
    12.
    Miyamoto S, Ujigawa K, Kizu Y, Tonogi M, Yamane GY Biomechanical three-dimensional finite-element analysis of maxillary prostheses with implants. Design of number and position of implants for maxillary prostheses after hemimaxillectomy. Int J Oral Maxillofac Surg 2010;39:1120-6.  Back to cited text no. 12
        
    13.
    Wang M, Qu X, Cao M, Wang D, Zhang C Biomechanical three-dimensional finite element analysis of prostheses retained with/without zygoma implants in maxillectomy patients. J Biomech 2013;46:1155-61.  Back to cited text no. 13
        
    14.
    Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med 2015;162:777-84.  Back to cited text no. 14
        
    15.
    Schardt C, Adams MB, Owens T, Keitz S, Fontelo P Utilization of the PICO framework to improve searching pubmed for clinical questions. BMC Med Inform Decis Mak 2007;7:16.  Back to cited text no. 15
        
    16.
    Ateş M, Cilingir A, Sülün T, Sünbüloğlu E, Bozdağ E The effect of occlusal contact localization on the stress distribution in complete maxillary denture. J Oral Rehabil 2006;33:509-13.  Back to cited text no. 16
        
    17.
    Kawasaki T, Takayama Y, Yamada T, Notani K Relationship between the stress distribution and the shape of the alveolar residual ridge–three-dimensional behaviour of a lower complete denture. J Oral Rehabil 2001;28:950-7.  Back to cited text no. 17
        
    18.
    Fatihallah AA Influence of occlusal schemes on the stress distribution in upper complete denture in centric and eccentric relation. J Baghdad College Dentistry 2005;17:17-20.  Back to cited text no. 18
        
    19.
    Cheng YY, Li JY, Fok SL, Cheung WL, Chow TW 3D FEA of high-performance polyethylene fiber reinforced maxillary dentures. Dent Mater 2010;26:e211-9.  Back to cited text no. 19
        
    20.
    Salih SI, Oleiwi JK, Hamad QA Numerically and theoretically studying of the upper composite complete prosthetic denture. Eng Technol J 2015;33:1023-37.  Back to cited text no. 20
        
    21.
    Sekinishi T, Inukai S, Murakami N, Wakabayashi N Influence of denture tooth thickness on fracture mode of thin acrylic resin bases: An experimental and finite element analysis. J Prosthet Dent 2015;114:122-9.  Back to cited text no. 21
        
    22.
    Lima JB, Orsi IA, Borie E, Lima JH, Noritomi PY Analysis of stress on mucosa and basal bone underlying complete dentures with different reliner material thicknesses: A three-dimensional finite element study. J Oral Rehabil 2013;40:767-73.  Back to cited text no. 22
        
    23.
    Mankani N, Chowdhary R, Mahoorkar S Comparison of stress dissipation pattern underneath complete denture with various posterior teeth form: An in vitro study. J Indian Prosthodont Soc 2013;13:212-9.  Back to cited text no. 23
        
    24.
    Tada S, Stegaroiu R, Kitamura E, Miyakawa O, Kusakari H Influence of implant design and bone quality on stress/strain distribution in bone around implants: A 3-dimensional finite element analysis. Int J Oral Maxillofac Implants 2003;18:357-68.  Back to cited text no. 24
        
    25.
    Mariano LOH, Sartori EA, Broilo JR, Shinkai RS, Corso L, Marczak RJ Stresses in implant-supported overdentures with bone resorption: A 3-D finite element analysis. Rev Odonto Ciênc 2012;27:41-6.  Back to cited text no. 25
        
    26.
    Kitamura E, Stegaroiu R, Nomura S, Miyakawa O Influence of marginal bone resorption on stress around an implant–a three-dimensional finite element analysis. J Oral Rehabil 2005;32:279-86.  Back to cited text no. 26
        
    27.
    Liu J, Pan S, Dong J, Mo Z, Fan Y, Feng H Influence of implant number on the biomechanical behaviour of mandibular implant-retained/supported overdentures: A three-dimensional finite element analysis. J Dent 2013;41:241-9.  Back to cited text no. 27
        
    28.
    Topkaya T, Solmaz MY The effect of implant number and position on the stress behavior of mandibular implant retained overdentures: A three-dimensional finite element analysis. J Biomech 2015;48:2102-9.  Back to cited text no. 28
        
    29.
    Hong HR, Pae A, Kim Y, Paek J, Kim HS, Kwon KR Effect of implant position, angulation, and attachment height on peri-implant bone stress associated with mandibular two-implant overdentures: A finite element analysis. Int J Oral Maxillofac Implants 2012;27:e69-76.  Back to cited text no. 29
        
    30.
    Alvarez-Arenal A, Gonzalez-Gonzalez I, deLlanos-Lanchares H, Brizuela-Velasco A, Martin-Fernandez E, Ellacuria-Echebarria J Influence of implant positions and occlusal forces on peri-implant bone stress in mandibular two-implant overdentures: A 3-dimensional finite element analysis. J Oral Implantol 2017;43:419-28.  Back to cited text no. 30
        
    31.
    Wen H, Guo W, Liang R, Xiang L, Long G, Wang T, et al. Finite element analysis of three zygomatic implant techniques for the severely atrophic edentulous maxilla. J Prosthet Dent 2014;111:203-15.  Back to cited text no. 31
        
    32.
    Tabata LF, Assunção WG, Barão VA, Gomes EA, Delben JA, de Sousa EA, et al. Comparison of single-standing or connected implants on stress distribution in bone of mandibular overdentures: A two-dimensional finite element analysis. J Craniofac Surg 2010;21:696-702.  Back to cited text no. 32
        
    33.
    Barão VA, Delben JA, Lima J, Cabral T, Assunção WG Comparison of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible—A computed tomography-based three-dimensional finite element analysis. J Biomech 2013;46:1312-20.  Back to cited text no. 33
        
    34.
    Barão VA, Assunção WG, Tabata LF, Delben JA, Gomes EA, de Sousa EA, et al. Finite element analysis to compare complete denture and implant-retained overdentures with different attachment systems. J Craniofac Surg 2009;20:1066-71.  Back to cited text no. 34
        
    35.
    Barão VA, Assunção WG, Tabata LF, de Sousa EA, Rocha EP Effect of different mucosa thickness and resiliency on stress distribution of implant-retained overdentures-2D FEA. Comput Methods Programs Biomed 2008;92:213-23.  Back to cited text no. 35
        
    36.
    El-Anwar MI, El-Taftazany EA, Hamed HA, ElHay MAA Influence of number of implants and attachment type on stress distribution in mandibular implant-retained overdentures: Finite element analysis. Open Access Maced J Med Sci 2017;5:244-9.  Back to cited text no. 36
        
    37.
    Hu F, Gong Y, Bian Z, Zhang X, Xu B, Zhang J, et al. Comparison of three different types of two-implant-supported magnetic attachments on the stress distribution in edentulous mandible. Comput Math Methods Med 2019;2019:6839517.  Back to cited text no. 37
        
    38.
    Ebadian B, Talebi S, Khodaeian N, Farzin M Stress analysis of mandibular implant-retained overdenture with independent attachment system: Effect of restoration space and attachment height. Gen Dent 2015;63:61-7.  Back to cited text no. 38
        
    39.
    Türker N, Büyükkaplan US, Sadowsky SJ, Özarslan MM Finite element stress analysis of applied forces to implants and supporting tissues using the “all-on-four” concept with different occlusal schemes. J Prosthodont 2019;28:185-94.  Back to cited text no. 39
        
    40.
    Kasani R, Rama Sai Attili BK, Dommeti VK, Merdji A, Biswas JK, Roy S Stress distribution of overdenture using odd number implants—A finite element study. J Mech Behav Biomed Mater 2019;98:369-82.  Back to cited text no. 40
        


        Figures

      [Figure 1]



     

    Top
     
     
      Search
     
    Similar in PUBMED
       Search Pubmed for
       Search in Google Scholar for
     Related articles
    Access Statistics
    Email Alert *
    Add to My List *
    * Registration required (free)

     
      In this article
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    References
    Article Figures

     Article Access Statistics
        Viewed259    
        Printed6    
        Emailed0    
        PDF Downloaded38    
        Comments [Add]    

    Recommend this journal


    [TAG2]
    [TAG3]
    [TAG4]