Evaluation of stresses in the mandible caused by loading of all-on-four and trefoil concepts under different occlusion conditions using finite element analysis.

IF 3.1 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Clinical Oral Investigations Pub Date : 2025-09-16 DOI:10.1007/s00784-025-06522-y

Berna Derinpınar, Esra Tsakir Emin, Merve Özarslan, Öznur Özalp, Alper Sindel, Mehmet Mustafa Özarslan, Mehmet Ali Altay, Nurullah Türker

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引用次数: 0

Abstract

Objectives: This study aimed to evaluate the maximum stresses on the bone, implant, and screw under four loading conditions in two implant-supported prosthesis concepts: Trefoil and All-on-Four.

Materials and methods: Three-dimensional mandibular models were created based on the All-on-Four and Trefoil concepts. Maximum bite forces were applied under four conditions: maximum intercuspal position, canine-protected occlusion, group-function occlusion, and cantilever loading. The stresses on cortical bone, implants, and screws were calculated using finite element analysis.

Results: The highest stresses under maximum bite forces occurred at the distal implants in the Trefoil model (393,9 MPa). The anterior implant (219,9 MPa), screw (171,1 MPa), and bone (29,7 MPa) in the Trefoil system experienced four times more stress than in the All-on-Four system (anterior implant 48,5 MPa, screw 50 MPa, bone 8,3 MPa). Canine-protected occlusion led to higher stresses on the working side. Stress concentrations were similar at the implant (trefoil right implant 23,7 MPa; middle 38 MPa; left 82,5 MPa; all on four right posterior implant 22,3 MPa; right anterior 12,7 MPa; left anterior 39,8 MPa; left posterior 86,8 MPa) and bone levels (trefoil right cortical bone 9,6 MPa; middle 2,07 MPa; left 11,1 MPa; all on four right posterior 7,5 MPa; right anterior 2,27 MPa; left anterior 1,8 MPa; left posterior 11,9 MPa) in both models, but higher stress was found around the screw of the central implant in the Trefoil system (53,8 MPa). Group-function occlusion resulted in higher stress at the implant (right 112,3 MPa; middle 124,6 MPa; left 776,2 MPa), screw (right 129,1 MPa; middle 239,9 MPa; left 474,3 MPa) and bone levels (right 66,1 MPa; middle 9,3 MPa; left 71,32 MPa) in the Trefoil model, with increased stress on the working side. Cantilever loading caused significant stress on abutment screws in the Trefoil model (right 42,2 MPa; middle 198,1 MPa; left 340,3 MPa), while the All-on-Four model (408,4 MPa) showed higher stress around the distal implants.

Conclusions: Canine-protected occlusion is recommended to minimize stress in both systems. Further clinical trials are needed to determine the optimal occlusion for implant prostheses.

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应用有限元分析方法评估不同咬合条件下全对四和三叶概念加载对下颌骨造成的应力。

目的：本研究旨在评估两种种植体支持的假体概念：三叶草和All-on-Four在四种载荷条件下对骨、种植体和螺钉的最大应力。材料和方法：基于All-on-Four和trifoil概念创建三维下颌模型。在四种情况下施加最大咬合力：最大尖间位置，犬保护咬合，群功能咬合和悬臂载荷。采用有限元分析计算皮质骨、种植体和螺钉的应力。结果：在最大咬合力下，三叶草模型中远端种植体的应力最大（393,9 MPa）。三叶草系统中前牙种植体（219,9 MPa）、螺钉（171,1 MPa）和骨（29,7 MPa）承受的应力是all - in - four系统（前牙种植体48,5 MPa、螺钉50 MPa、骨8,3 MPa）的4倍。犬类保护的咬合导致了工作侧更高的压力。种植体（三叶草右侧种植体23,7 MPa，中间38mpa，左侧82,5 MPa，所有四个右侧后种植体22,3 MPa，右侧前种植体12,7 MPa，左侧前种植体39,8 MPa，左侧后种植体86,8 MPa）和骨水平的应力浓度相似(三叶草右侧皮质骨9,6 MPa，中间2,07 MPa，左侧11,1 MPa，所有四个右侧后种植体7,5 MPa，右侧前种植体2,27 MPa，左侧前种植体1,8 MPa；左后侧11,9 MPa)，但在三叶草系统中，中央种植体螺钉周围的应力较高（53,8 MPa）。群功能闭塞导致三叶草模型种植体（右侧112,3 MPa；中部124,6 MPa；左侧776,2 MPa）、螺钉（右侧129,1 MPa；中部239,9 MPa；左侧474,3 MPa）和骨水平（右侧66,1 MPa；中部9,3 MPa；左侧71,32 MPa）应力升高，工作侧应力增加。悬臂载荷对三叶草模型的基牙螺钉产生明显的应力（右侧42,2 MPa；中间198,1 MPa；左侧340,3 MPa），而All-on-Four模型（408,4 MPa）远端种植体周围的应力较高。结论：推荐犬保护闭塞以减少两个系统的压力。需要进一步的临床试验来确定种植义齿的最佳咬合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Oral Investigations 医学-牙科与口腔外科

CiteScore

6.30

自引率

5.90%

发文量

484

审稿时长

3 months

期刊介绍： The journal Clinical Oral Investigations is a multidisciplinary, international forum for publication of research from all fields of oral medicine. The journal publishes original scientific articles and invited reviews which provide up-to-date results of basic and clinical studies in oral and maxillofacial science and medicine. The aim is to clarify the relevance of new results to modern practice, for an international readership. Coverage includes maxillofacial and oral surgery, prosthetics and restorative dentistry, operative dentistry, endodontics, periodontology, orthodontics, dental materials science, clinical trials, epidemiology, pedodontics, oral implant, preventive dentistiry, oral pathology, oral basic sciences and more.