Effect of Interproximal Contact on Load Transfer by Implant-supported 2-unit Cantilevered Prostheses
Purpose: The purpose of this study was to evaluate the effect of proximal contact on strain developed in implant-supported 2-unit cantilever.
Materials and methods: Two 10-mm long, Brånemark® Mk III implants (Noble Biocare, GÖteberg, Sweden), were placed vertically in the simulated bone model (acrylic resin model) at the position of first premolar and first molar. Strain gauges (model C2A-13-031 WW-350, Vishay MicroMeasurements Group Inc., Raleigh, North Carolina) were attached at the mesial and distal alveolar crest of the simulated bone at the first premolar implant. Static loads of 200 N were axially applied using a universal testing machine (Instron 5566; MA, U.S.A.) at the 10 mm distally from the center of first premolar implant. The specimens were divided into 4 groups; which were: 1) no proximal contact group or cantilever bridge 2)1x1 mm2 contact surface area group 3) 3x3 mm2 contact surface area group 4) splinted group. Maximum principal strains were determined for each interproximal contact designs. The study variables were analyzed using one way ANOVA and a significant level of 5% was applied throughout the analyses.
Result: Splinted group exhibited the lowest maximum principal strain, while no proximal contact group demonstrated the highest values. There were no statistically differences in maximum principal strains between the 1x1 mm2 and 3x3 mm2 contact surface area group. Greater strain values were found at the distal side of the implant compared to the mesial one in all groups, except splinted group (p – value < 0.05).
Conclusion: Splinted prostheses exhibited the best load sharing, followed by the designs with contact surface area and no contact, respectively. The size of contact surface area tends to show no effect on this study.
Branemark PI, Adell R, Breine U, Hansson BO, Lindstrom J, Ohlsson A. Intra-osseous anchorage of dental prostheses I. Experimental studies. Scand J Plast Reconstr Surg 1969;3(2):81-100.
Bragger U, Karoussis I, Persson R, Pjetursson B, Salvi G, Lang N. Technical and biological complications/failures with single crowns and fixed partial dentures on implants: a 10-year prospective cohort study. Clin Oral Implants Res 2005;16(3):326-334.
Pjetursson BE, Bragger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res 2007;18 Suppl 3:97-113.
Salinas TJ, Eckert SE. In patients requiring single-tooth replacement, what are the outcomes of implant- as compared to tooth-supported restorations? Int J Oral Maxillofac Implants 2007;22 Suppl:71-95.
Wennstrom J, Zurdo J, Karlsson S, Ekestubbe A, Grondahl K, Lindhe J. Bone level change at implant-supported fixed partial dentures with and without cantilever extension after 5 years in function. J Clin Periodontol 2004;31(12):1077-1083.
Halg GA, Schmid J, Hammerle CH. Bone level changes at implants supporting crowns or fixed partial dentures with or without cantilevers. Clin Oral Implants Res 2008;19(10):983-990.
Eliasson A, Eriksson T, Johansson A, Wennerberg A. Fixed partial prostheses supported by 2 or 3 implants: a retrospective study up to 18 years. Int J Oral Maxillofac Implants 2006;21(4):567-574.
Kreissl ME. Complex dental rehabilitation in a periodontally compromised patient. Part 2: treatment and discussion. Eur J Esthet Dent 2007;2(3):322-335.
Becker CM. Cantilever fixed prostheses utilizing dental implants: a 10-year retrospective analysis. Quintessence Int 2004;35(6):437-441.
Romeo E, Lops D, Margutti E, Ghisolfi M, Chiapasco M, Vogel G. Implant-supported fixed cantilever prostheses in partially edentulous arches. A seven-year prospective study. Clin Oral Implants Res 2003;14(3):303-311.
Johansson LA, Ekfeldt A. Implant-supported fixed partial prostheses: a retrospective study. Int J Prosthodont 2003;16(2):172-176.
Nedir R, Bischof M, Szmukler-Moncler S, Belser UC, Samson J. Prosthetic complications with dental implants: from an up-to-8-year experience in private practice. Int J Oral Maxillofac Implants 2006;21(6):919-928.
Zurdo J, Romao C, Wennstrom JL. Survival and complication rates of implant-supported fixed partial dentures with cantilevers: a systematic review. Clin Oral Implants Res 2009;20 Suppl 4:59-66.
Pjetursson BE, Tan K, Lang NP, Bragger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15(6):625-642.
Skalak R. Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent 1983;49(6):843-848.
Nissan J, Gross M, Shifman A, Assif D. Stress levels for well-fitting implant superstructures as a function of tightening force levels, tightening sequence, and different operators. J Prosthet Dent 2001;86(1):20-23.
MA EL, Elsaadawy MG, Abdou AM, Habib AA. Effect of different implant positions on strain developed around four implants supporting a mandibular overdenture with rigid telescopic copings. Quintessence Int 2013;44(9):679-686.
Rangert B, Jemt T, Jorneus L. Forces and moments on Branemark implants. Int J Oral Maxillofac Implants 1989;4(3):241-247.
Greenstein G, Cavallaro J, Jr. Cantilevers extending from unilateral implant-supported fixed prostheses: a review of the literature and presentation of practical guidelines. J Am Dent Assoc 2010;141(10):1221-1230.
Suedam V, Moretti Neto RT, Sousa EA, Rubo JH. Effect of cantilever length and alloy framework on the stress distribution in peri-implant area of cantilevered implant-supported fixed partial dentures. J Appl Oral Sci 2016;24(2):114-120.
Chandki R, Kala M. Natural tooth versus implant: a key to treatment planning. J Oral Implantol 2012;38(1):95-100.
Sallam H, Kheiralla LS, Aldawakly A. Microstrains around standard and mini implants supporting different bridge designs. J Oral Implantol 2012;38(3):221-229.
Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G. The influence of implant diameter and length on stress distribution of osseointegrated implants related to crestal bone geometry: a three-dimensional finite element analysis. J Prosthet Dent 2008;100(6):422-431.
Semper W, Heberer S, Nelson K. Retrospective analysis of bar-retained dentures with cantilever extension: marginal bone level changes around dental implants over time. Int J Oral Maxillofac Implants 2010;25(2):385-393.
Rangert B, Sennerby L, Meredith N, Brunski J. Design, maintenance and biomechanical considerations in implant placement. Dent Update 1997;24(10):416-420.
Blanes RJ, Bernard JP, Blanes ZM, Belser UC. A 10-year prospective study of ITI implants placed in the posterior region. II: Influence of the crown-to-implant ratio and different prosthetic treatment modalities on crestal bone loss. Clin Oral Implants Res 2007;18(6):707-714.
Aglietta M, Iorio Siciliano V, Blasi A, et al. Clinical and radiographic changes at implants supporting single-unit crowns (SCs) and fixed dental prostheses (FDPs) with one cantilever extension: a retrospective study. Clin Oral Implants Res 2012;23(5):550-555.
Kim P, Ivanovski V, Latcham N, Mattheos N. The impact of cantilevers on biological and technical success outcomes of implant-supported fixed partial dentures: a retrospective cohort study. Clin Oral Implants Res 2014;25(2):175-184.
Goiato MC, Shibayama R, Gennari Filho H, et al. Stress distribution in implant-supported prostheses using different connection systems and cantilever lengths: digital photoelastic. J Med Eng Technol 2016;40(2):35-42.
Sharma A, Rahul GR, Poduval ST, Shetty K. Assessment of various factors for feasibility of fixed cantilever bridge: a review study. ISRN Dent 2012;2012:259891.
Rubo JH, Souza EA. Finite element analysis of stress in bone adjacent to dental implants. J Oral Implantol 2008;34(5):248-255.
English CE. Biomechanical concerns with fixed partial dentures involving implants. Implant Dent 1993;2(4):221-242.
Korioth TW, Hannam AG. Deformation of the human mandible during simulated tooth clenching. J Dent Res 1994;73(1):56-66.
Guichet DL, Yoshinobu D, Caputo AA. Effect of splinting and interproximal contact tightness on load transfer by implant restorations. J Prosthet Dent. 2002;87(5):528-535.
Naves MM, de Menezes HH, de Magalhaes D, de Araujo CA, Junior PC. The influence of interproximal contact on implant-supported fixed partial dentures in the posterior jaw: a photoelastic analysis. J Oral Implantol 2015;41(1):3-9.
Lombardo L, Marcon M, Arveda N, La Falce G, Tonello E, Siciliani G. Preliminary biometric analysis of mesiodistal tooth dimensions in subjects with normal occlusion. Am J Orthod Dentofacial Orthop 2016;150(1):105-115.
Santoro M, Ayoub ME, Pardi VA, Cangialosi TJ. Mesiodistal crown dimensions and tooth size discrepancy of the permanent dentition of Dominican americans. Angle Orthodontist 2000;70(4):303-307.
English CE. Critical A-P spread. Implant Soc 1990;1(1):2-3.
Isidor F. Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys. Clin Oral Implants Res. 1996;7(2):143-152.
Sarig R, Lianopoulos NV, Hershkovitz I, Vardimon AD. The arrangement of the interproximal interfaces in the human permanent dentition. Clin Oral Investig 2013;17(3):731-738.
Tawil G, Aboujaoude N, Younan R. Influence of prosthetic parameters on the survival and complication rates of short implants. Int J Oral Maxillofac Implants 2006;21(2):275-282.
Resnik RR, Misch CE. Misch’s Avoiding Complications in Oral Implantology. 1st ed. St. Louis; Mosby: 2017. 711.
Peng ZZ, Chen XM, Wang J, Li AJ, Xu ZJ. Effect of proximal contact strength on the three-dimensional displacements of implant-supported cantilever fixed partial dentures under axial loading. J Zhejiang Univ Sci B 2013;14(6):526-532.
Campagni WV. The final touch in the delivery of a fixed Prosthesis. CDA J 1984;12(2):21-29.
Vertex-Dental B.V. [URL of homepage on internet] Netherland: Vertex-Dental Product Resources Online [Cited 2017 Feb 10]. Available from: http://www.vertex-dental.com/en/products/19-en/26/...
Coelho CSM, Biffi JCG, Silva GR, Abrahao A, Campos RE, Soares CJ. Finite element analysis of weakened roots restored with composite resin and posts. Dent Mater J 2009;28(6):671-678.