Effects of all-on-four implant designs in mandible on implants and the surrounding bone: A 3-D finite element analysis

Aims: The purpose of this study was to observe the stresses of all-on-four implant designs in an edentulous mandible in the implant, surrounding bone, and monolithic ceramics. Materials and Methods: In mandibular all-on-four implant models, anterior implants were placed vertically, and posterior implants were differently inclined. On the full-arch fixed prosthetic restoration monolithic zirconia framework, monolithic lithium disilicate was prepared as the superstructure. Model 1M (1M–15.5); posterior implants angled at 15° to the occlusion plane and a cantilever length of 5 mm, Model 2M; (2M–15.9), Model 3M; (3M–30.5), and Model 4M; (4M–30.9) were prepared. A total of 300 N bilateral force was applied at an angle of 30° and oblique to the occlusion plane. Stress values on dental implants, abutments, the surrounding bone, and prosthetic restorations were calculated. Results: The highest stress concentration was observed in the 2nd connector region between the canine and the 1st premolar tooth in the monolithic zirconia frameworks (457.21 MPa). Stress concentration in the cortical bone was 60.93 MPa in posterior implants. Stress was higher in posterior angled implants than straight implants. Stress at posterior angulation increased by 21 MPa in implants angled at 15°. Conclusion: In bilateral loading, the force applied to anterior implants does not have a significant effect on the bone structure. Stress concentration increases in posterior angled implants and surrounding bone. Moreover, stress concentration increases as the length of the cantilever, the weakest part in all-on-four implants, increases. As posterior implant angulation increases, stress concentration level and localization are affected.