Biomechanics of Dental Implants

Biomechanics of implants
Contents:
Introduction.
Loads applied to dental implants.
Mass, force and weight.
Types of forces.
Stress, strain relationship.
Force delivery and failure mechanisms.
Fatigue failure.
Scientific rationale for dental implant design.
Single tooth implant and biomechanics.
Cantilever prosthesis and biomechanics.
iomechanics of frame wor!s and misfit.
Treatment planning based on biomechanical ris! factors.
Conclusion.
"eferences.
Page #
INTRODUCTION:
iomechanics comprises of all !inds of interactions between tissues
and organs of the body and forces acting on them. It$s the response of the
biologic tissues to the applied loads.
%ental implants function to transfer load to surrounding biological
tissues. Thus the primary functional design ob&ective is to manage
'dissipate and distribute( biomechanical loads to optimi)e the implant
supported prosthesis function.
Definition
*rocess of analysis and determination of loading and deformation of
bone in a biological system.
+atural tooth ,s Implant-
+atural tooth Implant
#. +atural tooth is anchored in to
the bone by fle.ible periodontal
ligament.
/. The periodontal ligament
around the natural tooth
significantly reduces the amount
of stress transmitted to the bone
#. Implant is rigidly fi.ed by
functional an!ylosis.
/. The concentration of stresses
mainly occurs at the crestal
region.
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and facilitates even force
distribution.
0. The pdl acts as viscoelastic
shoc! absorber serving to
decrease the magnitude of stress
to the bone.
1. The precursor signs of a
premature contact or occlusal
trauma on natural teeth are
usually reversible and include
signs of cold sensitivity, wear
facets, pits, drift away and tooth
mobility.
2. This condition often helps in
the patient see!ing professional
treatment by occlusal ad&ustment
and a reduction in force
magnitude in force magnitude
which further reduces the stress
magnitude.
3. The elastic modulus of a tooth
is closer to the bone than any of
the currently available dental
implant biomaterial. The greater
0. The implant is fi.ed and rigid.
1. These initial reversible signs
and symptoms of trauma donot
occur with implants.
2. The magnitude of stress may
cause bone microfracture, bone
loss which ultimately leads to
mechanical failure of implant
components.
3. The implant materials differs by
24#5 times from the surrounding
bone structure.
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the fle.ibility difference between
the two materials, the greater the
potential relative motion
generated between the two
surfaces at the endosteal region.
6. The proprioceptive information
relayed by teeth and implants also
differs in 7uality. +atural teeth
deliver a rapid, sharp, high
pressure that triggers
proprioceptive mechanism.
8. The surrounding bone of
natural teeth is developed slowly
and gradually in response to
biomechanical loads.
9. : lateral force on natural tooth
is dissipated rapidly away from
the crest of bone toward the ape.
of the tooth.
6. Implants deliver a slow dull
pain that triggers a delayed
reaction if any.
8. ;here as the bone loading
around an implant is performed by
the dentist in a much more rapid and
intense fashion.
9. Lateral forces in implants
concentrates at the crestal
region.
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CHARACTER OF FORCES APPLIED TO DENTAL IMPLANTS-
<.cess loads on an osseointegrated implant may result in mobility
of supporting device and e.cessive loads also may fracture an implant
component or body. The internal stresses that develop in an implant
system and surrounding biological tissues under imposed load may have a
significant influence on the long term longevity of the implants in vivo. :
goal of treatment planning should be to minimi)e and evenly distribute
mechanical stress in implant system and contiguous bone.
LOADS APPLIED TO DENTAL IMPLANTS:
o In function = occlusal loads
o :bsence of function = *erioral forces
>ori)ontal loads
o Mechanics help to understand such physiologic and non physiologic loads
and can determine which t?t renders more ris!.
MASS, FORCE AND WEIGHT:
Mass : property of matter, is the degree of gravitational attraction the
body of matter e.periences.
@nit = !gs - 'lbm(
FORCE (SIR ISAAC NEWTON !"#$:
+ewton$s II law of motion
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F A ma
;here a A 9.8 m?s/
Mass = %etermines magnitude of static load
Force = Bilograms of force

WEIGHT:
Is simply a term for the gravitational force acting on an ob&ect at a
specified location.
FORCES AND FORCE COMPONENTS:
Magnitude, duration, direction, type and magnification
C,ector 7uantities$
%irection = dramatic influence
MOMENT % TOR&UE:
The force which tends to rotate a body. @nits = +.mD +.cm, lb.ft D o).in
In addition to a.ial force, there is a moment on the implant which is
e7ual to magnitude of force times 'multiplied by( the perpendicular
distance 'd( between the line of action of the F and center of the implant.
Page 3

FORCES ACTING ON THE IMPLANTS:
T'(ee t)*es of fo(+es a+tin, on t'e -enta. i/*.ants
Co/*(essi0e
Tensi.e
s'ea(
Compressive-
i( Tend to push masses towards each other.
ii( Maintains integrity of bone = implant interface.
iii( :ccommodated best.
iv( Cortical bone is strongest in compression.
v( Cements, retention screws, implant components and bone = implant
interfaces can accommodate greater compressive forces than tensile or
shear forces.
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vi( >ence compressive forces should be %ominant in implant
prosthetic occlusion.

TENSILE FORCES SHEAR FORCES

*ull ob&ects apart Sliding
%istract ? disrupt bone implant interface.
Shear forces are most destructive, cortical bone is wea!est to
accommodate shear forces.
Cylinder implants =in particular are highest ris! for shear forces at
the implant tissue interface unless an occlusal load directed along the long
a.is of the implant body.
They re7uire a coating to manage the shear forces to manage the shear
forces through a more uniform bone attachment.
Threaded ? finned implants impart a combination of all three types of
forces at the interface under the action of single occlusal load. This
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conversion of a single force in to three types of forces is controlled by the
implant geometry.
STRESS:
The manner in which a force is distributed over a surface is referred
as mechanical stress.
1 F%A
The magnitude of stress depends on two variables-
4 force magnitude.
4 cross sectional area over which the force is dissipated.
Fo(+e /a,nit2-e may be decreased by reducing magnifiers of force that
are-
#. Cantilever length
/. Crown height
0. +ight guards
1. Ecclusal material
2. Ever dentures
F2n+tiona. +(oss se+tiona. a(ea may be optimi)ed by-
#. increased by +umber of implants
/. Selecting an Implant geometry that has been designed carefully to
ma.imi)e the functional cross sectional area.
Page 9
DEFORMATION 3 STRAIN:
: load applied to a dental implant may induce deformation of the implant
and surrounding tissues
%eformation and stiffness of implant material may influence
A. Implant tissue Interface
B. Ease of implant manufacture
C. Clinical longevity
STRESS STRAIN RELATIONSHIP:

: relationship is needed between the applied stress that is imposed on
the implant and surrounding tissues and the subse7uent deformation.
The load values by the surface area over which they act and the strain
e.perienced by the ob&ect produces a stress strain curve.
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The slope of the linear portion of the curve is referred to as the modulus
of elasticity and its value indicates the stiffness of the material.
The closer the modulus of elasticity of the implant to the biological
tissues, the less the relative motion at the implant tissue interface.
Ence a particular implant system is selected the only way for an
operator to control the strain e.perienced by the tissues is to control the
applied stress or change the density of bone around the implant.
Freater the strength stiffer the bone
%ifference in stiffness is less for CpTi G %# bone but more for
%1 bone
Stress reduction in such softer bone
To reduce resultant tissue strain
Lower @ltimate strength
>oo!$s law
Stress A Modulus of elasticity . strain
A <.
4ITING FORCES:
:.ial component of biting force- '#55 = /255 +( ? '/6 = 225 lbs(
It tends to increase as one moves distally
Lateral component 4 /5 + 'appro..(
+et chewing time per meal A 125 sec
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Chewing forces will act on teeth for A 9 min?day
If includes swallowing A #6.2 min?day
Further be increased by parafunction
FORCE DELI5ER6 AND FAILURE MECHANISM:
The manner in which forces are applied to the dental implant restorations
within the oral environment dictates the li!elihood of system failure.
:n understanding of force delivery and failure mechanisms is critically
important to the implant practitioner to avoid costly and painful
complications.
The moment or tor7ue is the product of the force
magnitude multiplied by the perpendicular distance from the point of
interest to the line of the action of the force.
Moment loads are destructive in nature and may result in-
Interface brea!down
one resorption
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Screw loosening
ar ? bridge fracture
: total of si. moments may develop about the three clinical coordinate
a.es-
4 occlusoapical
4 faciolingual
4 mesiodistal
These moment loads induce microrotations and stress concentrations at
the crest of the alveolar ridge at the implant to tissue interface , which
lead inevitably to crestal bone loss. Three clinical moment arms in
implant dentistry
4 occlusal height
4 cantilever length
4 occlusal width

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Minimi)ation of each of these moment arms is necessary to prevent
unretained restorations, fracture of components, crestal bone loss or
complete implant system failure.
$ O++.2sa. 'ei,'t:
4 Ecclusal height serves as the moment arm for force components directed
along the faciolingual a.is-
4 wor!ing or balancing occlusal contacts, tongue thrusts or peri oral
musculature, and the force components directed along the mesiodistal
a.is.
4 force components along the vertical a.is is not affected by the occlusal
height because there is no effective moment arm.
4 in division : bone initial moment load at the crest is less than in
division C or % bone because the crown height is greater in Cand %.
7$ Canti.e0e( .en,t':
Large moments may develop from vertical a.is force components in
prosthetic environments designed with cantilever e.tensions or offset
loads from rigidly fi.ed implants.
: Lingual force component may also induce a twisting moment about the
implant nec! a.is if applied through a cantilever length.
Force applied directly over the implant does not induce a moment load or
tor7ue because no rotational forces are applied through an offset distance.
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:ntero posterior spread is the distance to the center of the most anterior
implant and the most distal aspect of the posterior implants.
The greater the :4* spread the smaller the resultant loads on the implant
system from cantilevered forced because of the stabili)ing effect of the
antero4posterior distance.
:ccording to MISCH
Cantilever length is determined by the amount of stress applied to system
Fenerally =%istal cantilever = not be H /.2 times of :4* spread
*atients with parafunction = not to be restored by cantilever.
S7uare arch form involves smaller :4* spreads between splited implants
and should have smaller length cantilever.
Tapered arch form = largest :4* spread = larger cantilever design.
8$9 O++.2sa. :i-t':
;ide occlusal tables increase the moment arm for any offset
occlusal loads. Faciolingual tipping 'rotation( can be reduced significantly
by narrowing the occlusal tables or ad&usting the occlusion to provide
more centric contacts.
: vicious destructive cycle can develop with moment loads and result
in crestal bone loss.
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FATIGUE FAILURE:
Fatigue failure is characteri)ed by %ynamic cyclic loading conditions,
four factors significantly influence the fatigue failure.
#( iomaterials
/( Feometry
0( Force magnitude
1( Loading cycles
$ 4io /ate(ia.s:
Fatigue behaviour of biomaterials is characteri)ed to a plot of applied
stress vs no. of loading cycles
>igh stress = few loading cycles
Low stress = infinite loading cycles
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Mo/ent .oa-s C(esta. ;one .oss
In+(eases o++.2sa. 'ei,'t
O++.2sa. 't9 /o/ent a(/
Fa+io.in,2a. /i+(o
(otation o( (o+<in,
Mo(e +(esta. ;one .oss
Fai.2(e if ;io/e+'ani+a.
en0i(on/ent is not +o((e+te-
Ti alloys e.hibits a higher endurance limit compared with
commercially pure titanium 'Cp Ti(
7$ Ma+(o ,eo/et():
The geometry of an implant influences the degree to which it can
"esists bending and tor7ue
Lateral loads also causes fatigue fracture
The fatigue failure is related as 1th power of the thic!ness difference
:lso affected by the difference in Inner and outer diameter of screw
and abutment screw space
8$ Fo(+e /a,nit2-e:
The magnitude of loads on dental implants reduced by careful
consideration of arch position
>igher loads on posteriors
Limitation of Moment loads
Feometry for functional area
Increasing the +o. of implants
=$ Loa-in, +)+.es
"educing the +o. of loading cycles
<limination of parafunction
"educing the occlusal contacts
SCIENTIFIC RATIONALE FOR DENTAL IMPLANT DESIGN
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%ental implants function to transfer of load to surrounding biologic
tissues.
Thus the primary functional design ob&ective is to manage 'dissipate and
distribute( biomechanical loads to optimi)e the implant supported
prosthesis function.
iomechanical load management depends on two factors that are
#( Character of applied load. /( Functional surface area
Forces applied to dental implant characteri)ed in terms of Magnitude,
duration, type, direction and magnification.
FORCE MAGNITUDE-
The magnitude of biting force varies as a function of
anatomic region and state of dentition. The magnitude of force is greater
in molar region and lesser in canine region.
>igher magnitude demands increased bone density and
Influence the selection of biomaterials.
Materials such as silicon hydro.yapatite and carbon are
characteri)ed by lesser ultimate strengths even though they are highly
compatible with the biological tissues.
In contemporary applications, these materials are
considered for use as coatings applied to stronger substrate materials.
Silicone, >:, carbon has4 >igh biocompatibility
4 Low ultimate strength
Titanium and its alloy = <.cellent biocompatibility
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4 Corrosion resistance
4 Food ultimate strength
4 Closest appro.. to stiffness of bone
FORCE DURATION:
The duration of bite forces on dentition has a wide range under ideal
conditionsD the total time of those brief episodes is less than 05 minutes
per day.
*atients who e.hibit bru.ism, clenching or other parafunctional habits
may have their teeth in contact several hours each day.
The endurance limit or fatigue strength is the level of highest stress
through whish a material may be cycled repetitively without failure. The
endurance limit of a material is often less than one half its ultimate tensile
strength.
The ability of implants and abutment screws to resist fracture from
bending loads is related directly to the moment of inertia of the
component.
This parameter is a function of the cross sectional geometry of the
component.
Implant bodies are particularly susceptible to fatigue fracture at the
apical e.tension of the abutment screw within the implant body or at
the crest module around abutment 'eg- with an internal he.agon(
The formula for the bending fracture resistance in these conditions is
related to the outer diameter radius to the fourth power minus the inner
diameter radius to the fourth power.
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The wall thic!ness of the implant body in this region controls the
resistance to fatigue failure. <ven a small increase in wall thic!ness
results in a significant increase in bending fracture resistance because
the dimension is multiplied to a power of four.
T6PE OF FORCE:
Three types of forces may be imposed on dental implants within the
oral environment
4Compression
4Tension
4Shear
one is strongest when loaded in compression. 05I wea!er when
sub&ected to tensile forces and 32I wea!er when loaded in shear
: smooth sided implant may be called a cylinder design, and this
cylinder implant body result in essentially a shear type of force at the
implant to bone interface. Thus this body geometry must use a
microscopic retention system by coating the implant with titanium plasma
spray or hydro.yl apatite
If the hydro.yapatite resorbs from infection or bone remodeling, the
remaining smooth sided cylinder is severely compromised for healthy
load transfer to the surrounding tissues
: threaded implant may use microscopic and macroscopic design
features to load the bone in compression and tensile loads
Threaded implants have the ability to transform the type of force
imposed at the bone interface through careful control of the thread
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geometry. Thread shape is particularly important in changing force type at
the bone interface
Thread shapes in dental implant design include s7uare, v shape and
buttress
@nder a.ial loads to a dental implant a v thread face 'typical of
paragon, 0i and +obel iocana( is comparable to the buttress thread and
has a #5 times greater shear component of force than a s7uare or a power
thread
: reduction in shear load at the thread to bone interface reduces the ris!
of overloadD which is particularly important in compromised %0 and %1
bone. : threaded implant also may have a surface condition such as
hydro.yapatite, T*S or other roughed surface.
FORCE DIRECTION:
The anatomy of the mandible and ma.illa places significant constraints
on the ability to surgically place root form implant suitable for loading
along their long a.is.
ony undercuts further constrain implant placement thus force
direction. Most of all undercuts occur on the facial aspects of the bone,
with the e.ception of the submandibular fossa in posteroior mandible.
>ence implant bodies often are angled to the lingual to avoid penetrating
the facial undercut during insertion.
:s the angle of the load increases, the stresses around the implant
increases, particularly in the vulnerable crestal bone region. :s a result all
implants are designed for placement perpendicular to the occlusal plane.
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This placement allows a more a.ial load to the implant body and reduces
the amount of crestal loss.
FORCE MAGNIFICATION-
There are various factors which can magnifies the forces on dental
implants
Surgical placement resulting in e.treme angulation of the implant
*ara functional habits
Cantilever and crown height
Increase in functional area
Increased density of the bone
Increase in implant number decreases cantilever length and limits
the force magnifier.
FUNCTIONAL SURFACE AREA:
Functional surface area is defined as the area that actively serves to
dissipate compressive and tensile non shear bonds through the implant to
bone interface and provides initial stability of the implant following
surgical placement.
The total surface area may include a passive area that does not
participate in load transfer.
Functional surface area also plays a ma&or role in addressing the
variable implant to bone contact )ones related to bone density.
Page //
%# bone, is the densest bone found in the &aws is also the strongest
bone and provides an intimate contact with a threaded root form implant
at initial implant loading.
%1 bone has the wea!est biomechanical strength and the lowest contact
area to dissipate the load at the implant to bone interface.
Thus an improved functional surface area per unit length of the implant
is needed to reduce the mechanical stress to this wea! bone.
Implant macrogeometry and implant width are two important design
variables for optimi)ing surface area.
IMPLANT MACROGEOMETR6-
The macro design or shape of an implant has an important
bearing on the bone response.
Frowing bone concentrates preferentially on protruding elements
of the implant surface, such as ridges, crests, teeth, ribs or the edge of
threaded surface.
The shape of the implant determines the surface area available
for stress transfer and governs the initial stability of the implant.
Smooth sided cylindrical implants provide ease in surgical
placement, however the bone to implant interface is sub&ected to
significantly larger shear conditions.
: smooth sided tapered implant allows for a component load to
be delivered to the bone implant interface, depending on the degree of
taper, however the greater the taper of smooth sided implant the less the
overall surface area of the implant body.
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Threaded implants with circular cross sections provide for ease
of surgical placement and allow for greater functional surface area
optimi)ation to transmit compressive loads to bone implant interface.
: smooth surface cylinder depends on a coating or
microstructure for load transfer to bone.
IMPLANT WIDTH:
:n increase in implant width ade7uately increases the area over which
occlusal forces may be dissipated.
;ider root form designs e.hibit a greater area of bone contact than
narrow implants of similar design because of an increase in
circumferential bone contact.
The larger the width of the implant the more it resembles the
emergence profile of the natural tooth.
The increased width of implants 34#/ mm also enhances the bending
fracture resistance. ut the crestal bone anatomy most often constrains
implant width to less than 2.2mm.
THREAD GEOMETR6
Threads are designed to ma.imi)e initial contact enhance surface area and
facilitate dissipation of stresses at the bone4 implant interface.
Functional surface area per unit length of the implant may be modified by
varying three thread geometry parameters
4 thread pitch
4 thread shape
Page /1
4 thread depth
THREAD PITCH:

Thread pitch is defined as the distance measured parallel with its a.is
between ad&acent thread forms or the number of threads per unit length in
the same a.ial plane or on the same side of the a.is.
The smaller the pitch 'finer( the more threads on the implant body for a
given unit length, and thus the greater surface area per unit length of the
implant body.
If force magnitude increase or bone density decreases one may decrease
the thread pitch to increase the functional surface area.
Some of the current popular designs which have different pitches.
The distance between pitches-
Page /2
ITI Implant = #.2mm
Sterioss 4 5.8mm
+obel biocare,)immer, 0i G life core = 5.3mm
iohori)ons 4 5.1mm
4the fewer the threads , the easier to bond or insert the implant.
THREAD SHAPE-
Thread shapes in implant geometry 'dental implant designs include
s7uare, ,shape and buttress.
The , shape thread design is called a fi.ture and is primarily used
for fi.ating metal parts together not load transfer.
The buttress thread shape was designed initially for and is optimi)ed
for pullout loads.
The s7uare or power threaded provides an optimi)ed surface area
for intrusive, compressive load transmission.
The shear force on a , threaded face 'typical of Jimmer, 0i and
+obel biocare( is about #5 time greater than the shear force on a s7uare
thread.
Page /3
T>"<:% %<*T>-
The threaded depth refers to the distance between the ma&or and minor
diameter of the thread.
the greater the thread depth, the grater the surface area of the implant if
all the other factors are e7ual.
IM*L:+T L<+FT>-
:s the length of an implant increases so does the overall total surface
area.
%# bone is the strongest and densest bone of the oral environment. The
strength of the bone and the intimate contact between the bone and
implant provide resistance to lateral loading. icortical stabili)ation is not
needed in %# bone because it is already a homogenous cortical bone.
: long implant in %/ or %0 bone in the anterior mandible may cause
increased surgical ris!, since attempting to engage the opposing cortical
plate and preparing a longer osteotomy may result in overloading of the
bone.
In poor 7uality %0 and %1 bone functional surface area must be
ma.imi)ed to distribute occlusal loads optimally, the placement of longer
implants in posterior regions re7uire surgical modifications li!e nerve
repositioning, placement of sinus grafts in ma.illary posterior regions.
The shorter and smaller diameter implants had lower survival rates than
their longer or wider counter parts.
CREST MODULE CONSIDERATIONS-
Page /6
Crest module of an implant body is the transosteal region from the
implant body and characteri)ed as a region of highly concentrated
mechanical stress.
Slightly larger than outer diameter, thus the crest module seats fully
over the implant body osteotomy, providing a deterrent for the ingress of
bacteria or fibrous tissue.
The seal created by the larger crest module also provides for greater
initial stability of the implant following placement.
*olished collar '5.2 mm( = perigingival area, provides for a desirable
smooth surface close to the perigingival area.
Longer polished collar = shear loading = crestal bone loss
one is often lost to first thread, because the first thread changes the
shear force of the crest module to a component of compressive force in
which bone is strongest.
:*IC:L %<SIF+ CE+SI%<":TIE+S-
"ound cross sectional implants do not resist torsional shear
forces when abutment screws are tightened hence anti rotational feature is
incorporated usually in the apical region of the implant body, with a hole
or vent. one can grow through the apical hole and resist torsional loads
applied to the implant. The apical hole region may increase the surface
area available to transmit compressive loads on the bone.
The disadvantage of the apical hole occurs when the implant
is placed through the sinus floor or becomes e.posed through a cortical
plate. The apical hole may fill with mucous and become a source of
Page /8
retrograde contamination. :nother anti rotational feature of implant body
may be flat sides or grooves along the body or apical region of the
implant body.
The apical end of each implant should be flat rather than
pointed, this allows for the entire length of the implant to incorporate
design features that ma.imi)e desired strain profiles.
P(o,(essi0e Loa-in,
Mis+' (>"?$ proposed that
Fradual increase in occlusal load separated by a time interval to allow
bone to accommodate.
Softer the bone increase in progressive loading period.
P(oto+o. In+.2-es,
Time
%iet
Ecclusal Contacts and occlusal material
*rosthesis %esign
Ti/e:
Page /9
Two surgical appointments between initial implant placement and stage
II uncovery may vary on density.
%# 4 0 Months
%/ 4 1 Months
%0 4 2 Months
%1 4 3 Months
Diet:
Limited to soft diet = #5 pounds
Initial delivery of final prosthesis4/# pounds
O++.2sa. Mate(ia.:
Initial step = no occlusal material placed over implant
*rovisional = :crylic = lower impact force
Final 4 Metal ? *orcelain
O++.2sion:
Initial 4 +o occlusal contact
*rovisional 4 Eut of occlusion
Final 4 :t occlusion
P(ost'esis Desi,n:
First transititional = +o occlusal contact
Page 05
+o cantilever
Second transititional 4 Ecclusal contact
;ith no cantilever
Final restoration 4 narrow occlusal table and cantilever with implant
protective occlusion guidelines.
SINGLE TOOTH IMPLANTS-
Single tooth implants re7uire good bone support and control of
harmful effects of occlusal levers that are not parallel to the long a.is of
the implant.
The prosthesis must be designed to allow good oral hygiene, with
easy access to inter pro.imal surfaces and the retaining screw.
: molar can be replaced with two standard diameter implants or one
wide implant.
This type implant is contraindicated for larger spaces because the
masticatory and occlusal forces to the most distal or mesial portions will
be harmful.
To avoid e.cessive loads, the implant must be centered in the
edentulous space during placement.
Page 0#
ANTERIOR SINGLE TOOTH RESTORATIONS:
The anterior single tooth restoration is achieved using a standard
diameter implant, which is preferred over a narrow implant because it
provides a larger surface for osseo integration
Fenerally the use of wide implants in this area is not advocated because
it may compromise good esthetic results.
To avoid levers that may be produced during parafunction in centric
and eccentric positions, its recommended that the implant supported
restoration be left out of occlusion.
S>E"T S*:+ FIK<% *:"TI:L %<+T@"<-
The construction of a 0 unit particularly cantilever fi.ed
partial dentures re7uire a posterior triangular )one of occlusal surface
between the supporting implants.
The chances of overloading the implants are far less and
this provides a better long term prognosis, because it offers a wider
active )one while also achieving good occlusal load in relationship to the
a.es of the implants. the use of wide implants to support cantilever fi.ed
partial dentures improves the prognosis further, especially in those cases
where only two wide implants are needed compared to three of standard
diameter. wide implants allow for an increased occlusal surfaces in these
circumstances.
Page 0/
The pro.imity of anatomical features such as the
mandibular canal or the ma.illary sinus limit the use of long implants. In
the presence of ade7uate bucco lingual bone width these limitations ca be
managed with the use of wide implants.
C:+TIL<,<" FIK<% *:"TI:L %<+T@"<-
It results in greater tor7ue with distal abutment as fulcrum.
May be compared with Class I lever arm.
May e.tend anterior than posterior to reduce the amount of force
It depends on stress factors
*arafunction
Crown height
Impact width
Implant +umber
The design of cantilever fi.ed partial dentures is dependent on the
occlusal forces that can be elicited at the free end of the denture and the
length and width of the implants selected.
C:S< #-
: case with two implants placed for the lateral incisor and the canine
with a free end central incisor.
Two implants of ade7uate length are re7uired.
The cantilever tooth should avoid contacts on the central incisors
during protrusion, lateral e.cursions and ma.imum intercuspation.
Page 00

C:S< II-
;hen the implants serve as support for the central and lateral incisors
with a free end canine, the occlusal configuration should provide group
function during lateral movements and avoids loading of canine.
If it$s not possible lateral guidance may be provided by the central and
lateral incisors avoiding any contact with the canine.

C:S< III-
;hen two implants are placed unilaterally at the site of two ma.illary
premolars, the free end canine must be left out of occlusion.
Page 01
C:S< I,-
Molar replacements achieve best results with a three Implant supported
fi.ed prosthesis providing premolar morphology to the restorations.
The length of the implants influences the outcome of treatment
%ue to the enormous occlusal loads in the second molar area the use of
a free end fi.ed prosthesis is contra indicated.

4IOMECHANICS OF FRAMEWOR@S AND MISFIT
F(a/e:o(<s:
Metal framewor! for full arch prosthesis can fracture
More towards the cantilever section
Reasons:
$ Everload of cantilever
@nli!ely to occur = typical prosthetic alloy.
/( Metallurgic fatigue under cyclic loads
*revention = substantial cross sectional area
Page 02
= 043 mm
TREATMENT PLANNING 4ASED ON 4IOMECHANICAL RIS@
FACTORS
%esign of final prosthetic reconstruction
:natomical limitation
Geo/et(i+ (is< fa+to(
#( +o. of implants less than no. of root support
Ene implant replacing a molar = ris!.
# wide = plat form implant ? / regular implants
Two implants supporting 0 roots or more = ris!
/ wide = platform implants
/( ;ide = platform implants
"is! = if used in very dense bone
0( Implant connected to natural teeth
1( Implants placed in a tripod configuration
%esired counteract lateral loads
Page 03
2( *resence of prosthetic e.tension
3( Implants placed offset to the center of the prosthesis in tripod
arrangement, offset is favorable.
6( <.cessive height of the restoration
OCCLUSAL RIS@ FACTORS:
Force intensity and parafunctional habit
*resence of lateral occlusal contact
Centric contact in light occlusion
Lateral contact in heavy occlusion
Contact at central fossa
Low inclination of cusp
"educed si)e of occlusal table
4ONE IMPLANT RIS@ FACTORS
%ependence on newly formed bone
:bsence of good initial stability
Smaller implant diameter
*roper healing time before loading
1 mm diameter minimum = posteriors
Te+'no.o,i+a. (is< fa+to(s
Page 06
Lac! of prosthetic fit and cemented prostheses
*roven and standardi)ed protocols
*remachined components
Instrument with stable and predefined tightening tor7ue
WARNING SIGNS:
= "epeated loosening of prosthetic ? abutment screw
= "epeated fracture of veneering material
= Fracture of prosthetic ? abutment screws
= one resorption below the first thread
CONCLUSION:
iomechanics is one of the most important
consideration affecting the design of the frame wor! for an implant bone
prosthesis. It must be analy)ed during diagnosis and treatment planning as
it may influence the decision ma!ing process which ultimately reflect on
the implant supported prosthesis.
REFERENCES
#. %ental implant prosthetics = Carl <. Misch
Page 08
/. *rinciples and practice of implant dentistry = Charles ;eiss, :dam
;eiss.
0. Tissue = integrated prosthesis. Esseointegration in clinical dentistry
= ranemar!, )arb, :lbre!tsson
1. Eral rehabilitation with implant supported prosthesis 4,incente
2. ITI dental implants4 Thomas F.;ilson
Page 09

Biomechanics of Dental Implants

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