A 3-Dimensional Finite Element Analysis of Resected Mandibular Bone to Determine the Most Stable Implant Positions for a Fixed Prosthesis.

This study was conducted to determine the most secure implant positioning on the marginally resected mandible to support a fixed complete denture through finite element analysis. Three or 4 implants were placed at near, middle, or far positions from the resected margin in a simulation model with a symmetrical marginal defect in the mandibular symphysis. The height of the residual bone was 5, 10, or 15 mm. The 4 possible implant patterns for 3 or 4 implants were defined as (1) asymmetrically isolated position 1 to position 2, (2) asymmetrically isolated position 1 to position 3, (3) asymmetrically isolated with greater-length position 1 to position 2, and (4) 2 implants symmetrically positioned on each side of the defect. The von Mises stress in the resected and peri-implant bone with respect to the occlusal force was calculated. Initially, because the peri-implant bone stress around the isolated implant at the near position was greater than at the middle and far positions regardless of the residual bone height, the near position was excluded. Second, the von Mises stress in the resected bone region was >10 MPa when the isolated implant was at the far position, and it increased inversely depending on the bone height. However, the stress was <10 MPa when the isolated implant was placed at the middle position regardless of the bone height, and it was significantly lower compared with the far position and equivalent to the symmetrically positioned implants. Furthermore, the use of a greater-length implant reduced peri-implant bone stress, which was even lower than that of the symmetrically positioned implants. These results suggest that the asymmetrically positioned 3-implant-supported fixed denture, using a greater-length isolated implant, placed neither too close to nor too far from the resected margin, can be an effective alternative to the symmetrically positioned 4-implant-supported fixed denture.