UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3771

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Mechanical behavior of implant-supported full-arch prostheses in

diﬀerent locations in the maxilla: 3D-FEA and strain gauge analysis

Comportamento mecânico de próteses de arco inteiro implanto-suportadas em localizações diferentes na maxila: análise

3D-FEA e strain gauge

Mateus Favero Barra GRANDE

, Guilherme da Rocha Scalzer LOPES

, Marcelo Lucchesi TEIXEIRA

,

André Antônio PELEGRINE

, Jefferson David Melo de MATOS

, Renato Sussumo NISHIOKA



1 - São Paulo State University, Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São José dos

Campos, SP, Brasil.

2 - São Leopoldo Mandic University, Department of Dental Prosthodontics, Campinas, SP, Brasil.

How to cite: Grande MFB, Lopes GRS, Teixeira ML, Pelegrine AA, Matos JDM, Nishioka RS. Mechanical behavior of implant-supported

full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis. Braz Dent Sci. 2023;26(2):e3771. https://doi.

org/10.4322/bds.2023.e3771

ABSTRACT

The maxillary bone restriction can limit the implants position to support a full-arch prosthesis. Objective:

Therefore, this study evaluated the biomechanical behavior of a full-arch prosthesis supported by six implants in

different congurations: group A (implants inserted in the region of canines, rst premolars and second molars),

group B (implants inserted in the region of rst premolar, rst molar and second molar) and group C (implants

in second premolar, rst premolar and second molar). Material and Methods: The models were analyzed by

the nite element method validated by strain gauge. Three types of loads were applied: in the central incisors,

rst premolars and second molars, obtaining results of von-Mises stress peaks and microstrain. All registered

results reported higher stress concentration in the prosthesis of all groups, with group C presenting higher values

in all structures when compared to A and B groups. The highest mean microstrain was also observed in group C

(288.8 ± 225.2 με/με), however, there was no statistically signicant difference between the evaluated groups. In

both groups, regardless of the magnitude and direction of the load, the maximum von-Mises stresses recorded for

implants and prosthesis displacements were lower in group A. Conclusion: It was concluded that an equidistant

distribution of implants favors biomechanical behavior of full-arch prostheses supported by implants; and the

placement of posterior implants seems to be a viable alternative to rehabilitate totally edentulous individuals.

KEYWORDS

Dental implants; Biomechanical phenomena; Dental prosthesis; Finite element analysis; Maxilla.

RESUMO

A limitação óssea maxilar totais pode limitar o posicionamento dos implantes para suportar uma prótese de arco

total. Objetivo: Sendo assim, este estudo avaliou o comportamento biomecânico de uma prótese de arco total

suportada por seis implantes em diferentes congurações: grupo A (implantes inseridos na região de caninos,

primeiros pré-molares e segundos molares), grupo B (implantes inseridos na região de primeiro pré-molar,

primeiro molar e segundo molar) e grupo C (implantes em segundo pré-molar, primeiro pré-molar e segundo

molar). Materiais e métodos: Os modelos foram analisados pelo método de elementos nitos validados por

extensometria. Foram aplicados três tipos de cargas: nos incisivos centrais, primeiros pré-molares e nos segundos

molares, obtendo resultados de picos de tensão de von-Mises e microdeformação. Todos os resultados registrados

mostraram maior concentração de tensão na prótese de todos os grupos, sendo que o grupo C apresentou maiores

valores em todas as estruturas quando comparado com os grupos A e B. A maior média de microdeformação

também foi observada no grupo C (288,8 ± 225,2 με/με), no entanto, não houve diferença estatisticamente

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

INTRODUCTION

Implants with external hexagon-type

connections presents biomechanical characteristics

with acceptable immediate performance as well

as in the long-term follow-up. For this and other

reasons, xed prostheses on external hexagon

implants are a very popular option in the

treatment of edentulous patients [1].

However, for rehabilitation with an

implant-supported restoration, it is necessary

to have adequate bone remnant to support the

masticatory loads. After tooth extraction or tooth

loss, the alveolar bone undergoes a physiological

remodeling process that often limits the amount

of bone, especially in the anterior region of

the maxilla; dampening the oral rehabilitation

in this region [2]. Thus, there are two major

clinical procedures that can provide the necessary

anchorage in these areas: bone grafting or the

use of long implants in the posterior region with

anchorage in other portions of the bone tissue [3].

It is important to emphasize that the use of long

implants with zygomatic anchorage, in addition

to being invasive and requiring hospitalization,

usually has a high cost to the patient [4].

A clinical option that overcomes these

limitations would be the implant placement in

the posterior region of the maxilla. However, this

treatment option can present complications in

the long-term due to the lack of standardization

of it and mechanical studies supporting its

indication [5]. The two major factors of implant

failure are: peri-implantitis and occlusal overload.

Both factors can act together or independently

and cause peri-implant marginal bone loss that,

in advanced cases, can lead to implant loss [6,7].

When the chewing loading mechanical stimuli

are within physiological limits, they will result

in the maintenance of the bone level, however,

when the stimuli exceed the physiological limits,

the consequence is a bone loss caused by the

disorganization of the remodeling process [8].

Therefore, to avoid the marginal bone loss, it is of

great importance to know how the masticatory loads

can modify the biomechanical behavior of implant

prosthesis [9], since the condition of the marginal

bone of an implant in function is inuenced by

transmitted occlusal forces to him [10].

Axial loads transmit stresses along to the

implant axis more homogeneously than oblique

loads, being considered more friendly by the

peri-implant bone tissues [11,12]. However,

the positioning of implants and the framework

of a prosthesis on implants can influence the

distribution of occlusal loads and result in a

greater presence of oblique loads, which intensify

the magnitude of stresses transferred to the

marginal bone [13]. In order to improve the

understanding of the biomechanical behavior of

xed prostheses on implants, in vitro and in silico

studies have been used through bioengineering

tools, such as the numerical analysis using the

nite element methods [14].

Finite element method allows simulating

the possible stresses in the theoretical model.

This methodology has the advantage of allowing

simulation of various well-controlled conditions,

allowing the analysis of the biomechanical behavior

of implants in areas of difcult clinical access [15].

However, it can give more reliable results when

associated with in-vitro methods such as strain

gauge analysis. Therefore, this research aimed to

evaluate the stress and strain distribution of implant-

supported full-arch prostheses with different

implant configurations and load conditions.

The null hypothesis was that the microstrains would

be similar regardless the simulated condition.

MATERIAL AND METHODS

3D modelling

The external hexagon implant and

prosthetic screw were created according to the

manufacturer’s dimensions (Intraoss, Sistemas

signicativa entre os grupos avaliados. Em todos os grupos, independentemente da magnitude e direção da carga,

as tensões máximas de von-Mises registradas para os implantes e deslocamentos de próteses foram menores no

grupo A. Conclusão: Concluiu-se que a distribuição de implantes de forma equidistante favorece o desempenho

biomecânico das próteses de arco total suportada por implantes; e o posicionamento de implantes posteriores

parece ser uma alternativa viável para reabilitar indivíduos densdentados totais.

PALAVRAS-CHAVE

Implantes dentários; Fenômenos biomecânicos; Prótese dentária;, Análise de elementos nitos; Maxila.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

de Implantes, Itaquaquecetuba, SP, Brazil)

using Computer- Aided-Design (CAD) software

(Rhinoceros 5.4.2, SR8, McNeel North America,

Seattle, WA, USA). To design the maxillary and

prosthesis’ 3D model, a real polyurethane maxilla

model and prothesis were digitalized (Scanner

trios 3, open format in STL) allowing the

acquisition of the stereolithography (.STL) le.

After that, the computational analysis was

performed simulating this reference model in

three groups with different configurations of

implant placement and transferred to a CAD

software for the elaboration of the volumetric

model.

The STL file was converted using the

Rhinoceros software (version 5.4.2 SR8, McNeel

North America, Seattle, WA, USA), using reverse

engineering tool. The fixed prosthesis on the

implants were modeled with the same steps as

the maxilla from the STL le generated by the

CAD software. After, the 3D model was nally

nished as a volumetric model (Figure 1).

Boundary conditions

After modelling, the three-dimensional

model was imported into Ansys software (ANSYS

16.0, ANSYS Inc., Houston, TX, USA) in order

to carry out a static structural analysis. Material

properties were used from software database.

The geometries were renamed according to what

they are representing, and all structures were

considered linear, homogeneous, isotropic and

elastic. After checking the contact between the

structures, they are considered bonded and the

number of faces tangent between two solids were

adjusted with similar quantity (Figure 2).

The meshing process has been carried out

automatically, in which the software allowed the

renement of the mesh created using tetrahedral

elements.

Figure 1 - (A) Model generated based on the external geometry of the pre-existing model; (B) Implant-supported prosthesis designed in CAD

software; (C) Model was transformed into a volumetric solid; (D) Pre-existing physical model that served as the basis for the digital archives

and for the in-vitro strain measurement.

Figure 2 - Model A: implants inserted in the region of canines, ﬁrst premolars and second molars. Model B: implants inserted in the region of

the ﬁrst premolar, ﬁrst molar and second molar. Model C: implants inserted in the region of second premolar, ﬁrst premolar and second molar.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

For each load (axial and non-axial)

an analysis configuration was used. For all

configurations, the maxilla was fixed on its

lower external surface simulating the support

of the model in a plane. Load was dened as

vector in the Z-axis direction with 300N force

on premolars and molars, 100N on maxillary

central incisors. After the simulations, von-Mises

stress solutions were conducted for the implants,

prosthetic screws and the maxillary model for

each load (Figure 3).

In-vitro strain assessment

To validate the FEA model an in-vitro model

was design with similar conditions. The surfaces

of the model were prepared and cleaned with

isopropyl alcohol and electric linear strain gauges

(KFG-02-120-C1-11, Excel Sensores Industria e

Comercio., Ltd –Taboão da Serra– SP, Brazil)

were bonded. Each sensor was positioned close to

the implant using a transparent adhesive tape and

a cyanoacrylate-based adhesive (Super Bonder

Loctite, São Paulo – Brazil).

The model received similar loads following

FEA with a 2 mm diameter rounded tip as

the load application device [16]. Variations

in electrical resistance were transformed

into microstrain units using an electrical

signal conditioning device (Model 5100B

Scanner – System 5000 – Instruments Division

Measurements Group, Inc. Raleigh, North

Carolina – USA, FAPESP proc: 07/53293-4).

Data recording was performed using strain-

smart software. Electrical cables allowed the

connection between the strain gauges and the

data acquisition device (Figure 4).

It was possible to observe for each image

that the hot colors represent the zones with the

highest stress concentration (von-Mises Stress),

that is, regions under higher stress and for each

analyzed structure.

RESULTS

The implant-supported prosthesis was the

structure with the highest stress peak for the

three groups, which could be observed that in the

region of the most mesial implants. However, the

maxillary model did not show a high magnitude

of stress regardless the different conditions, in

addition to the mesial region of the rst implant

(gures 5-7) (Table I).

Figure 3 - Loading simulation: (A) Oblique loading in central incisors; (B) simulation of axial loading in ﬁrst premolars; (C) axial loading on

second molars; (D) model ﬁxation for load application and, (E) perspective view of the diﬀerent loading conditions.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

Figure 4 - Model with strain gauges bonded in the model surface. Occlusal view (A) and lateral view detailing the position each sensor (B).

Figure 5 - Von-Mises Stress (MPa) results in the bone tissue for loading in central incisors (A-C), in the ﬁrst premolars (D-F) and upper molars

(G-I) according to the three diﬀerent models.

Table I - Stress peaks (MPa) calculated according the diﬀerent models (A, B and C) as well as the loading region for each of the evaluated structure

Structure Loading condition Model A Model B Model C

Maxilla

Incisor 44 13 65

Pre molars 47 50 68

Molars 47 23 94

Implant

Incisor 31 68 61

Pre molars 43 47 77

Molars 55 96 151

Screw

Incisor 57 96 68

Pre molars 65 65 102

Molars 74 133 253

Prosthesis

Incisor 77 99 128

Pre molars 98 150 159

Molars 87 168 441

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

Therefore, for the oblique loads applications,

it was possible to observe a lower concentration of

stress and deformation in the structures furthest

from the loading regions and higher stresses in

the regions closer to the load application point.

When the load was ap-plied in a region of the

rst molar of the prosthesis, the stresses were

distributed more homogeneously between the

evaluated structures.

Observing the deformation distribution

generated in group C, it is possible to notice that the

magnitude of the deformation peak is concentrated

in the more mesial implants when the load applied

to the centrals compared to groups A and B.

For strain gauge analysis, statistical tests

were performed using the R-project 3.2.0 software

(Table II). The signicance level established for

Figure 6 - Von-Mises Stress (MPa) results in the dental implant for loading in central incisors (A-C), in the ﬁrst premolars (D-F) and upper molars

(G-I) according to the three diﬀerent models.

Figure 7 - Von-Mises Stress (MPa) results in the prosthetic screw for loading in central incisors (A-C), the ﬁrst premolars (D-F) and upper molars

(G-I) according to the three diﬀerent models.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

the tests was equal to 5%, which established a

95% condence interval for the presented results

(Table III). Therefore with similar mechanical

behavior between in-vitro strain peaks and

theoretical stress peaks, the model has been

considered validated.

With values of p < 0.05 for the Shapiro-Wilk

test, the distribution of deformations (Strain) was

considered non-normal. Kruskal-Wallis statistical

test was applied to assess the relationship between

each model and its strains. The results obtained

showed no statistical difference (p = 0.902) for the

evaluated groups when considering the average

strain per model (Table III).

For each load application point, the Kruskal-

Wallis test and Dunn’s multiple comparison test

were used. It was possible to observe that there was

no statistical difference for the different loading

conditions (X2 = 2.486, df = 5, p = 0.778).

DISCUSSION

This study evaluated the influence on

external hexagon implants in three different

designs of multiple implant-supported prostheses

in edentulous maxilla. The null hypothesis was

partially accepted since the microstrain were

similar between the groups. However, it was also

possible to observe that the greater the lever arm

in the anterior region, the greater the magnitude

of the stresses calculated for the implants and

structures of the prosthetic system.

According to the literature [17], in silico

methods such as nite element analysis, can be

used to measure bone behavior. The use of such 3D

method requires prior knowledge of bone volume

and mechanical properties. However, the bone tissue

is not homogeneous and its physical properties vary

greatly according to species, age, sex, type of bone

(e.g., femoral, mandibular, cortical, cancellous) and

even according to location of the bone from which

the sample was taken [18,19].

Therefore, studies with human bone have

a complexity and heterogeneity and, for ethical

reasons, often delay the development of clinical

trials. Thus, through an in vitro study, a previous

study evaluated the elastic modulus of an

experimental polyurethane isotropic model, by

means of stress tests and compared the results

with those reported in the literature with

bone [19,20]. According to them, the use of the

polyurethane model in place of bone in in vitro

biomechanical studies is a validated method.

Based on that, the present study used the in vitro

polyurethane model and simulated the numerical

model with the properties of this isotropic model.

In the present results, the disposition of

the implants to distal in the edentulous maxilla

Table II - Strain peaks (microstrain) calculated according the diﬀerent models (A, B and C) as well as the loading region (Incisors, Pre molars

and Molars) for each of strain gauge

Group

Loading

condition

Guage 1 Guage 2 Guage 3 Guage 4 Guage 5 Guage 6

Group A

Incisor 40.7 -30.6 -90.1 -88.2 -28.4 65

Pre molars 47 124 -8.7 -7.6 116.3 68

Molars 190.2 40.4 20 18.7 47.1 186.9

Group B

Incisor -9.7 24.8 -390.1 -377.8 27.1 -10.2

Pre molars 70.4 110.2 -160.4 -158.7 109.5 68.2

Molars 180.7 49.6 349.2 352.5 52.3 174.3

Group C

Incisor -18.1 31.4 -514.4 -502.7 28.3 -21.2

Pre molars 96.5 120.1 -181.2 -176.3 125.2 89.4

Molars 201.5 59.4 390.7 402.6 48.3 190.3

Table III. Kruskal-Wallis table according to each model

Model με/με (dp) X

df p-value

A 241.2±178.9 0.205 2 0.902

B 258.8± 201.4

C 288.8±225.2

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

caused a higher stress concentration for the

analyzed structures, in accordance with previous

studies that reported a similar behavior, when the

distance between the implants increased [21-23].

A previous study [24] reported that implants

installed respecting the minimum space between

each implant (3 mm) demonstrated a better

mechanical response of the bone tissue to

masticatory loads. In this way, the use of

six adjacent implants in the posterior region

(Group C) allowed an acceptable mechanical

behavior of the peri-implant bone under load.

Therefore, the results obtained for the different

implant positions clearly indicated that the stress

was lower in model A compared to other models

B and C.

The stress in the implant and in the framework

increased as the implants were installed distally

to the molar region. Therefore, the more distal

the conguration of the implants, the greater

the distance between the anterior abutments of

the implant. When the load was on the central

incisors, the amount of stress concentration were

visibly higher compared to the similar loading

condition in model A. This nding is consistent

with the study of previous authors [25], who

found that cantilever loading had a large effect on

stress concentration. Increased stress can increase

the risk of treatment failure [12]. The results

obtained in the present study also indicated

that anterior cantilever can negatively affect the

implant stress magnitude.

Although the positions of implants B and C

can be considered almost similar, the loading on

the central incisors increased the stress on the

mesial implant in group C compared to group

B, showing that these designs present different

mechanical response.

Another novelty of the present study in

relation to previous reports in the literature

was the verification of stress, considering a

cantilever prosthesis in the anterior maxillary

implants. Although this factor has been evaluated

in previous studies [12,21-26], there is lack of

information when considering different implant

positions. The literature [21-27] usually reports

the maximum forces capable of generating

mechanical problems in the bone-implant

interface, however, there are no reports showing

the cantilever in anterior region.

It is noteworthy that this study was subject

to some limitations, as the loading condition

was simplified [28-30]. Axial loads transmit

stresses along the axis of the implant in a more

homogeneous way, being better accepted by the

peri-implant bone tissues [31,32]. However, the

positioning of the implants and the framework

of a prosthesis on implants can influence the

distribution of occlusal loads and result in a

greater amount of oblique loads, which intensify

the magnitude of the stresses transferred to the

marginal bone [33]. In order to improve the

understanding of the biomechanical behavior

of fixed prostheses on implants, in vitro and

in silico studies have gained notoriety through

bioengineering tools, such as, for example,

analyzes by FEA and strain gauge [30-33].

Future studies should apply different bone

densities, anatomical structures such as the

maxillary sinus and diversify the size and

angulations of implants for this situation.

Furthermore, although the experimental models

were rigorously prepared and experienced

dentists were involved in all procedures, the bone

model is still an isotropic structure that is limited

in terms of mechanical response. Therefore, it is

not recommended to extrapolate these results

to implant-supported prostheses in clinical

situations, and further studies should be carried

out to assess the effect of traction forces on the

biomechanics of these prostheses. However,

despite all the limitations, the present results

can be used to guide further in-vitro studies and

to elucidate how the implants distribution and

loading condition can modify the mechanical

behavior of the full-arch prothesis on implants.

CONCLUSIONS

According with the obtained results and

model validation it is possible to conclude that

the implants inserted in the region of canines,

rst premolars and second molars showed the

most promising mechanical behavior, while the

distal implants placement showed the highest

stress. However, the positioning of implants in the

posterior region of the maxilla seems to be a viable

alternative to rehabilitate edentulous maxilla.

Acknowledgements

I appreciate the support of Intraoss(R) Warie

Industrial LTDA. CNPJ: 10.615.047/0001-13.

Brazil, Itaquaquecetuba - SP. By donating all

implants used in the research.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

Author’s Contributions

MFBG: Conceptualization, Methodology,

Software, Validation, Formal Analysis,

Investigation, Resources, Data Curation, Writing

– Original Draft Preparation, Writing – Review

& Editing, Visualization, Supervision, Project

Administration and Funding Acquisition. GRSL:

Conceptualization, Methodology, Validation,

Formal Analysis, Writing – Original Draft

Preparation. MLT: Formal Analysis. AAP: Formal

Analysis, Investigation, Resources, Data Curation,

Writing – Original Draft Preparation. JDMM:

Resources, Writing – Original Draft Preparation.

RSN: Conceptualization, Writing – Original

Draft Preparation, Writing – Review & Editing,

Visualization, Supervision, Project Administration

and Funding Acquisition.

Conict of Interest

The authors declare no conict of interest.

Funding

Agência de Fomento FAPESP, n. de processo:

2018/04454-0, 2019/24903-6 and 2021/11499-2.

Regulatory Statement

This study was conducted in accordance with

all the provisions of the local human subjects

oversight committee guidelines and policies.

REFERENCES

1. Misch CE, Suzuki JB, Misch-Dietsh FM, Bidez MW. A positive

correlation between occlusal trauma and peri-implant bone

loss: literature support. Implant Dent. 2005;14(2):108-16. http://

dx.doi.org/10.1097/01.id.0000165033.34294.db. PMid:15968181.

2. Andrade GS, Kalman L, Giudice RL, Adolfi D, Feilzer AJ, Tribst JP.

Biomechanics of implant-supported restorations. Braz Dent Sci.

2023;26(1):e3637. http://dx.doi.org/10.4322/bds.2023.e3637.

3. Kizhakedathil MPJ, C SD. Acid stable α -amylase

from

Pseudomonas balearica

VITPS19-Production, purification

and characterization. Biotechnol Rep (Amst). 2021;30:e00603.

http://dx.doi.org/10.1016/j.btre.2021.e00603. PMid:33747801.

4. Davó R, Bankauskas S, Laurincikas R, Koçyigit ID, Mate Sanchez

de Val JE. Clinical performance of zygomatic implants-

retrospective multicenter study. J Clin Med. 2020;9(2):480.

http://dx.doi.org/10.3390/jcm9020480. PMid:32050501.

5. Kreissl ME, Gerds T, Muche R, Heydecke G, Strub JR. Technical

complications of implant-supported fixed partial dentures in

partially edentulous cases after an average observation period

of 5 years. Clin Oral Implants Res. 2007;18(6):720-6. http://

dx.doi.org/10.1111/j.1600-0501.2007.01414.x. PMid:17888017.

6. Lindhe J, Meyle J, Group D of European Workshop on

Periodontology. Peri-implant diseases: Consensus Report of the

Sixth European Workshop on Periodontology. J Clin Periodontol.

2008;35(8, Suppl):282-5. http://dx.doi.org/10.1111/j.1600-

051X.2008.01283.x. PMid:18724855.

7. Malchiodi L, Cucchi A, Ghensi P, Consonni D, Nocini PF. Influence

of crown-implant ratio on implant success rates and crestal

bone levels: a 36-month follow-up prospective study. Clin Oral

Implants Res. 2014;25(2):240-51. http://dx.doi.org/10.1111/

clr.12105. PMid:23402530.

8. Frost HM. Wolff’s Law and bone’s structural adaptations to

mechanical usage: an overview for clinicians. Angle Orthod.

1994;64(3):175-88. PMid:8060014.

9. Kayumi S, Takayama Y, Yokoyama A, Ueda N. Effect of bite force

in occlusal adjustment of dental implants on the distribution

of occlusal pressure: comparison among three bite forces in

occlusal adjustment. Int J Implant Dent. 2015;1(1):14. http://

dx.doi.org/10.1186/s40729-015-0014-2. PMid:27747636.

10. Tribst JPM, Dal Piva AMO, Borges ALS, Rodrigues VA, Bottino

MA, Kleverlaan CJ. Does the prosthesis weight matter? 3D

finite element analysis of a fixed implant-supported prosthesis

at different weights and implant numbers. J Adv Prosthodont.

2020;12(2):67-74. http://dx.doi.org/10.4047/jap.2020.12.2.67.

PMid:32377319.

11. Sahin S, Cehreli MC, Yalçin E. The influence of functional forces

on the biomechanics of implant-supported prostheses--a review.

J Dent. 2002;30(7-8):271-82. http://dx.doi.org/10.1016/S0300-

5712(02)00065-9. PMid:12554107.

12. Sahin S, Cehreli MC, Yalçin E. The influence of functional forces

on the biomechanics of implant-supported prostheses--a review.

J Dent. 2002;30(7-8):271-82. http://dx.doi.org/10.1016/S0300-

5712(02)00065-9. PMid:12554107.

13. Datte CE, Tribst JP, Dal Piva AO, Nishioka RS, Bottino MA,

Evangelhista AM, et al. Influence of different restorative

materials on the stress distribution in dental implants. J Clin

Exp Dent. 2018;10(5):e439-44. http://dx.doi.org/10.4317/

jced.54554. PMid:29849967.

14. Farah JW, Craig RG, Sikarskie DL. Photoelastic and finite

element stress analysis of a restored axisymmetric first molar.

J Biomech. 1973;6(5):511-20. http://dx.doi.org/10.1016/0021-

9290(73)90009-2. PMid:4748499.

15. Tribst JPM, Dal Piva AMO, Lo Giudice R, Borges ALS, Bottino

MA, Epifania E,etal. The influence of custom-milled framework

design for an implant-supported full-arch fixed dental prosthesis:

3D-FEA sudy. Int J Environ Res Public Health. 2020;17(11):4040.

http://dx.doi.org/10.3390/ijerph17114040. PMid:32517097.

16. Lopes GDRS, Matos JDM, Queiroz DA, Tribst JPM, Ramos NC,

Rocha MG,etal. Influence of abutment design on biomechanical

behavior to support a screw-retained 3-unit fixed partial denture.

Materials (Basel). 2022;15(18):6235. http://dx.doi.org/10.3390/

ma15186235. PMid:36143553.

17. Silveira MPM, Campaner LM, Bottino MA, Nishioka RS, Borges

ALS, Tribst JPM. Influence of the dental implant number and load

direction on stress distribution in a 3-unit implant-supported

fixed dental prosthesis. Dent Med Probl. 2021;58(1):69-74.

http://dx.doi.org/10.17219/dmp/130847. PMid:33687804.

18. O’Mahony AM, Williams JL, Katz JO, Spencer P. Anisotropic

elastic properties of cancellous bone from a human edentulous

mandible. Clin Oral Implants Res. 2000;11(5):415-21. http://dx.doi.

org/10.1034/j.1600-0501.2000.011005415.x. PMid:11168233.

19. Miyashiro M, Suedam V, Moretti Neto RT, Ferreira PM, Rubo

JH. Validation of an experimental polyurethane model for

biomechanical studies on implant supported prosthesis--

tension tests. J Appl Oral Sci. 2011;19(3):244-8. http://dx.doi.

org/10.1590/S1678-77572011000300012. PMid:21625741.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3771

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses in different locations in the maxilla: 3D-FEA and strain gauge analysis

Grande MFB et al.

Mechanical behavior of implant-supported full-arch prostheses

in diﬀerent locations in the maxilla: 3D-FEA and strain gauge

analysis

20. Bölükbaşı N, Yeniyol S. Number and localization of the implants for

the fixed prosthetic reconstructions: on the strain in the anterior

maxillary region. Med Eng Phys. 2015;37(4):431-45. http://dx.doi.

org/10.1016/j.medengphy.2015.02.004. PMid:25765190.

21. Hekimoglu C, Anil N, Cehreli MC. Analysis of strain around

endosseous dental implants opposing natural teeth or implants.

J Prosthet Dent. 2004;92(5):441-6. http://dx.doi.org/10.1016/j.

prosdent.2004.07.023. PMid:15523333.

22. Almeida EO, Rocha EP, Freitas AC Jr, Anchieta RB, Poveda

R, Gupta N,etal. Tilted and short implants supporting fixed

prosthesis in an atrophic maxilla: a 3D-FEA biomechanical

evaluation. Clin Implant Dent Relat Res. 2015;17(Suppl 1):e332-

42. http://dx.doi.org/10.1111/cid.12129. PMid:23910435.

23. Liu X, Pang F, Li Y, Jia H, Cui X, Yue Y,etal. Effects of different

positions and angles of implants in maxillary edentulous jaw

on surrounding bone stress under dynamic loading: a three-

dimensional finite element analysis. Comput Math Methods Med.

2019;2019:8074096. http://dx.doi.org/10.1155/2019/8074096.

PMid:31933678.

24. Tribst JPM, Dal Piva AMO, Bottino MA, Nishioka RS, Borges ALS,

Özcan M. Digital image correlation and finite element analysis

of bone strain generated by implant-retained cantilever fixed

prosthesis. Eur J Prosthodont Restor Dent. 2020;28(1):10-7.

http://dx.doi.org/10.1922/EJPRD_1941Tribst08. PMid:31638348.

25. Wu AY, Hsu JT, Fuh LJ, Huang HL. Biomechanical effect of implant

design on four implants supporting mandibular full-arch fixed

dentures: invitro test and finite element analysis. J Formos

Med Assoc. 2020;119(10):1514-23. http://dx.doi.org/10.1016/j.

jfma.2019.12.001. PMid:31883628.

26. Tribst JP, Rodrigues VA, Dal Piva AO, Borges AL, Nishioka

RS. The importance of correct implants positioning and

masticatory load direction on a fixed prosthesis. J Clin Exp

Dent. 2018;10(1):e81-7. http://dx.doi.org/10.4317/jced.54489.

PMid:29670721.

27. Tribst JPM, Rodrigues VA, Borges ALS, Lima DR, Nishioka RS.

Validation of a Simplified Implant-Retained Cantilever Fixed

Prosthesis. Implant Dent. 2018;27(1):49-55. http://dx.doi.

org/10.1097/ID.0000000000000699. PMid:29341975.

28. Datte CE, Datte FB, Borges ALS, Campos JF, Lopes GDRS, Tribst

JPM,etal. The influence of restorative material, bone height and

implant system on the stress distribution of implant-supported

posterior crowns. Int J Dev Res. 2021;11:44925-31.

29. Ahmed MA, Hamdy AM, Fattah GA, Effadl AK. Prosthetic

design and restorative material effect on the biomechanical

behavior of dental implants: strain gauge analysis. Braz Dent

Sci. 2022;25(3):e3380. http://dx.doi.org/10.4322/bds.2022.

e3380.

30. Ozan O, Ramoglu S. Effect of implant height differences on

different attachment types and peri-implant bone in mandibular

two-implant overdentures: 3D finite element study. J Oral

Implantol. 2015;41(3):e50-9.; http://dx.doi.org/10.1563/AAID-

JOI-D-13-00239. PMid:24471769.

31. Paes T Jr, Tribst JP, Dal Piva AM, De Figueiredo VM, Borges AL,

Inagati CM. Influence of fibromucosa height and loading on the

stress distribution of a total prosthesis: a finite element analysis.

Braz Dent Sci. 2021;24(2):1-7.

32. Matos JDM, Lopes GDRS, Nakano LJN, Ramos NC, Vasconcelos

JEL, Bottino MA,etal. Biomechanical evaluation of 3-unit

fixed partial dentures on monotype and two-piece zirconia

dental implants. Comput Methods Biomech Biomed Engin.

2022;25(3):239-46. http://dx.doi.org/10.1080/10255842.202

1.1946798. PMid:34559574.

33. Matos JD, Gomes LS, de Carvalho Ramos N, Queiroz DA, Tribst

JP, Campos TM,etal. Influence of CAD/CAM Abutment Heights

on the Biomechanical Behavior of Zirconia Single Crowns.

Metals (Basel). 2022;12(12):2025. http://dx.doi.org/10.3390/

met12122025.

Mateus Favero Barra Grande

(Corresponding address)

São Paulo State University, Department of Dental Materials and Prosthodontics,

Institute of Science and Technology, São José dos Campos, SP, Brasil.

Email: mateus.grande@unesp.br

Date submitted: 2023 Jan 07

Accept submission: 2023 Apr 10