Biomechanical analysis of inclined and cantilever design with different implant framework materials in mandibular complete-arch implant restorations

Inclined distal implants with posterior framework cantilevers are an alternative to straight implants for the treatment of edentulous jaws, avoiding grafting procedures and utilizing pre-existing bone. However, little is known about the implant, framework, and peri-implant bone stresses exerted by this design.The purpose of this finite element analysis study was to assess the biomechanical properties of the inclined versus straight design, with different implant framework material to generate implant-supported complete-arch fixed mandibular prostheses.A finite element model of the edentulous mandible was generated by using 4 implants in 2 distinct configurations: the inclined design and the straight design. Different framework materials were tested: pure titanium, cobalt-chromium alloy, type IV gold alloy, zirconia, polyetheretherketone (PEEK), and carbon fiber-reinforced polyetheretherketone (CFR-PEEK). A 300-N load at a 75-degree angle was applied to the occlusal plane from the lingual side of the buccal cusps of the 2 premolars and the first molar teeth. Subsequently, stresses on the implant, surrounding bone, and framework were measured and analyzed quantitatively and qualitatively.In terms of implant configurations, the inclined design demonstrated less stress on the posterior cortical bone, implants, and framework than the straight design. Comparing the framework materials, zirconia and metal exhibited reduced cortical bone and implants stresses but elevated framework stress when compared with the polymeric frameworks.From a biomechanical viewpoint, in edentulous patients with excessive posterior alveolar bone resorption, the inclined design exhibited more favorable stress distribution around the posterior implants than the straight design. In implant-supported complete-arch fixed mandibular prostheses, zirconia and metal, particularly cobalt-chromium alloy, distributed the stresses more effectively to the implants and supporting bone than polymeric materials.