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Evaluation of Strain at the Terminal

Abutment Site of a Fixed Mandibular
Implant Prosthesis During
Cantilever Loading
Arthur M. Rodriguez, DMD, MS, * Steven A. Aquilino, DDS, MS, f
Peter S. Lund, IIDS, MS,$ Je$;ey S. Rjther, DDS,MS,$
Thomas E. Southard, DDS, MSg
Purpose: Cantilever lengths from 10 mm t o 20 mm have been empirically recommended for
Brsnemark fixed mandibular implant prostheses. However, functional stresses generated within the
framework and at the crestal bone associated with various cantilever lengths have not been well
researched. The purpose of this investigation was t o evaluate the strain generated within an
implant-supported prosthesis and on a simulated bone surface during functional cantilever loading.
Materials end Methods: A symmetrical mandibular fixed-implant framework supported by six
Nobelpharma 7.0 x 4.0-mm abutments and 15.0 x 4.0-mm fixtures wasfabricated. The fixtures were
embedded in a simulated bone matrix of polymethyl methacrylate resin. Fourteen different
arrangements of active supporting abutments were tested during 15 Ib unilateral static cantilever
loading 7 mrn, 14 mm and 20 mm distal to the terminal abutments. T-rosette strain gauges were
placed immediately distal to the terminal abutment site on the right side of the framework and on
the corresponding simulated bone surface.
Results: There was no difference in framework microstrain as abutment number and arrangement were varied. Microstrain distal t o the terminal abutment increased significantly with
increasing cantilever length. Distal abutment microstrain increased 213% (63 p e to 197 pe) when
cantilever length was increased from 7 mm t o 14 mm and an additional 55% (197 peto 306 pe) when
cantilever length was increased from 14 mm to 20 mm. Overall, microstrain increased 306% when
cantilever length was increased from 7 rnrn to 20 mm. Microstrain on the framework was always
tensile (positive). Microstrain at the simulated bone reached higher maximum levels than on the
framework (-588 p e versus 314 pe) and was compressive in nature (negative). In contrast t o
framework microstrain, microstrain at the simulated bone site varied dramatically with changes in
abutment arrangement. Strains observed at the simulated bone surface increased dramatically as
the distance t o the adjacent active abutment increased or as the anterior-posterior span of
abutments decreased. Distal abutment microstrain also increased significantly at the bone site as
cantilever length increased, however, percent increases were less (7 mm t o 14 mm, 55%; 14 mm t o
20 mm, 30%; 7 mm t o 20 mm, 101%).
Conclusions: The results of this study indicate that an optimum biomechanical environment
should exist when cantilever spans exceeding 7 mm are planned regardless of the number of
supporting abutments. Strain transmitted to the crestal bone can be decreased by maximizing the
number and anterior-posterior spread of supporting fixtures while minimizing the distance between
the distal abutment and its adjacent abutment.
J Prosthod 2:93-102. Copyright 1993 by the American College of Prosthodontists.
INDEX WORDS: implant biomechanics, implant cantilever, abutment arrangement, implant
framework, implant prosthesis

From the linzverszg o,fIozh$a,College $Dmtzstv, Iorra CIQ,IA.
*Graduatestudent. Drfinrtriicnt ofPrmthodnntirr.
i.4swaate PmjAsor ~71dGraduate Program Dzrector, Department $
Prvsthodonlic~
$Aswtnnt Projsm. Ll@ntrncnt ofPmrthodonttcr
QAsmtantPrujssor. Ilepartment of Orthodontzr
Funded 4) the QLnan Graduate Student Research S~pporfAurard,
A m a c n n Academ3 $Fixed Prosthodont~cs

HE CLASSIC MANDIBULAR implant prosthe-

T

sis as described by Brinemark et all is predicatrd upon the retention of four to six implant
fixtures placed between the mental foramina. The
prosthesis is attached to the implant fixtures and
extended distally Using bilateral cantilevered segm e n t ~ . 'Various
-~
cantilever lenpths have been emnir-

prostheses, the forces these cantilever designs place
Journal qfioslhodontics, T/ol2,Xo 2 (June). I.99.7:pp 93-I02

93

The framework was cast in a 79% palladium.Option I. hlicromeasureinents Group Inc. The fixtures were then inserted through holes provided in an indexed silicone lid (Rrgisil. DE). Nine millimeters of acqlic resin were p r o d e t l apical to the implant fixtures. . MY) (Fig 1). Dentsply International Inc) and allowed to polymer- Figure 1. Loading p i n t grooves approximately0. Rornulus. The assembly weighed 15 Ibs (6. The tesl framework was fabricated to conform to a symmetrical archform configuration. The loading rod was supported by a horizontal ball bearing housing attached to a steel base-androd assernbly similar t o a ring ?tanti (Fig 4). l'hc implant fixtures were embedded to a level just above the top screw thread. The fixed detachable mandibular test framework was waxrd using 9.75-kg)loadwas applied to the cantilcver segments of the framework. Six abutment replicas (Nobelpharma LJSA Inc. Resin mandible matrix and lid assembly (inferior view). The complex was allowed to remain undisturbed for 1 weck to allow completc polymerization shrinkage. Strain gauges recorded strain immcdiately distal to the terminal abutment site on the framework and the resin simulated hone surface.5 mm in depthwere incorporated at points 7 mm. Resin foot tabs wcrc provided on the inferior surface of the simulated mandible to aid in stabilization during loading.The arrangement maintained 8 mm between the edges of adjacent abritmrnt replicas and an 18 mm anterior-posterior span. werc varied. Rangert e t al. 14 mm. Dentsply International Inc). St Paul. The loacling apparatus consisted of a cylinder filled with lead shot supportrd by a 12-mm-diameter steel rod fitted with a custom acrylic loading point. their description of the biomechanical forces and the influence uf cantilever length. 'l'he waxed pattern was 7 to 8 mm in faciolingual width and 3 mm in occlusogingival ihickness. q u ~et~al upon t h e implant fixtures and prosthetic components has not been well researched. T h e purpose of this study was t o evaluate how strain varied with increasing cantilever lengths and changes in number a n d arrangement of active abutm e n t s for a fixed mandibular implant prosthesis. The simulated mandible was poured with clear polymet hyl met hacvlat e resin (Orthodontic Resin.0-mm titanium abutments (Nobelpharma USA Inc) and 15-mm titanium fixturcs (Nobelpharma USA Inc) were attached to the frameworkwith gold screws (Nobelpharma USA Inc). ize for 20 niinutes under 9 kg of pressure. number. The resin mandible was fabricated from a silicone matrix (Rzprosil Putty. Raleigh. Cantilever length: as well as the nurnher and arrangerncnt of active abutments.75 kg). a 3-mm strut was waxed to the occlusal surface of the lingual circumference for increased rigidity. KerrSybron Corp. Dentsply International Inc.' and Brunski8 have studied t h e biomechanical forces associated with implant-supported prostheses. In addition. and 20 mm from the centcr of the last abutment along each cantilever extension. MI). The implant fixtures were embedded in a polymethyl methacrylate resin archfnrm simulating the human mandible. However. Milford.j Skalak. Upon recovery from the matrix. Chicago. The indcxcd lid ensurcd uniform placement of the fixtures within the rcsin niandible matrix (Fig 2). the framework demonstrated a clinically acceptable passive fit (Fig 3 ) . A I5-lb (6. Test framework. Six 7. 2% gold alloy (Porcelain No. The resin mandible vms then wrapped circumferentially in a 5-mm-thick layer of silicone putty and cmbedded in dental stone for stabilization during loading. NC) were bondcd immediately distal to each implant fixture and gold cylinder on the right Figure 2. Abutment sites were designated as 1 through 6 from the left to the right side of the framework.0mm gold cylinders (Nobelpharma USA Inc). Materials and Methods A test framework supported by six implant fixtures and abutments was fabricated. 79. Mowrey Co.. IL) were ernbedded in type IV dcntal stonc (Vel-Mix Dental Stone. Six T-rosette strain gauges (EA-30-030TU-120. and arrangement of implant fixtures as well a s prosthesis design were mathematical and theoretical in nature.94 Eualuatzotr ofstrain K o d n .

The two grids of the T-rosette gauges allowed strain to be recorded separately in two directions. faciolingual (F/L) and mesiohstal (M/D) (Fig 5). and 6) and at the corresponding simulated bone surface implant fixtures sites (A. The F/L and M/D strains were recorded separately Tor each strain gauge. strain was recorded at all active framework abutment sites (nos. Fixture/framework assembly in resin mandi- Figure 5. C) during 15 lb (6. resin mandible. All bonding sites were on the superior surfacr of the framework and resin. All recordings were repeated three times. 4.3.June 199. Number 2 95 Figure 3. The three recordings were avcraged and the range of recordings was Figure 6. allowing the strain indicator to recover to -+OOOO strain before reloading. sitcs. and 20 m m distal to the center of the terminal abutment on both the right and left sides of the framework were tested. Variables Investigated For all test conditions.75 kg) static cantilever loading (Fig 6). 5. 14 mm. Six cantilever loading sites 7 mm. side of the prosthesis/resiii mandible complex with MBond 200 cyarioacrylate adhesive (Micromeasurernents Group Inc). Loading appdrdtlls. Volume 2. ‘I’-rosrtte strain gauges bonded to simulatrd ble. . Diagram of test framework and recording Figure 4. this article will only report on data recorded at the terminal framework and bone level sites (6 and C). B. However.

X. Vm. A total of I008 recordings were made. is a function of gauge orientation and location. Framework Strain The mean values for PVI/D microstrain for all cantilever lengths at the terminal abutment framework sitc during same side loading are listed in Table 6. IX. 111. The arrangements tested are presented in Table 1. Positive strain (+) indicates tension and negative strain (-) indicates compression.XII. TV. Fourteen variations of abutment number and arrangement werc tested. inactive abutment. Framework Microstrain ( PE)at Distal Abutment Recordinq Site Durinq Same-Side Loading Arrangement SD LS (mm) I II III IV V IT Vfl VIII IX X XI XI XIII XrV . for all loading point/arrangemcnt combinations at the distal abutment recording sites on the framework and simulated resin mandible. noted to assess the reliability of the recording system. However. XIV. 11. VI. A 213%increase in strain occurred as cantilever length Table 2. are presented in Tables 2 through 5. thus changing the number and arrangement of active abutments supporting the framework. the mean range for this data (28 FE)was only 11. Examination of the raw data (Tables 2 through 5) indicated good reliability of the recording system given the small ranges of microstrain relative to mean microstrain values. XI. Same-side loading refers to cantilever loading on the right side or the framework adjacent to the strain gauge recording sites. Xm.2% of the mean microstrain (250 KE). Selected abutments were removed.96 Evaluation aJ Strain Arrangement Numb 6 5 5 5 5 4 Results 1-2-3-4-5-6 1-2-3-4-X-6 1-2-3-X-5-6 1-2-X--1-5-6 1-X-3-4-5-6 1-X-X-4-5-6 1-2-x-x-5-6 1-2-x-4-x-6 1-X-3-4-X-6 1-2-3-x-x-6 1-2-X-X-X-6 1-X-X-I-X-6 1-X-3-X-X-6 1-X-X-X-5-6 Iv V \17 im VIII Ix X XI 3 3 3 3 to 10 N c ~ with n a torque driver (Nobelpharma USA Inc) . The order of arrangements tested was chosen to produce as little manipulation as possible to the system during abutment arrangement changing. Opposite-side loading refers to loading at the threc cantilevcr loading points on the left side of the framework. Fixture Arrangements Tested Number of Act we Abutmentr 0 xu xm XIV Abbrmiations: X. Thc largest rangcs werc recorded for M/D bone level microstrain during same side loading (Table 4). The type of strain recorded. For each arrangement. Arrangement Pattern I I1 I11 4 4 4 4 Rodriguez et al - Table 1. The arrangement scquencc tested was: I. VII. all abutment screws were secured with tight finger pressure using a hand wrench (Nobelpharma USA Inc) and all gold screws were tightened The means of the three recordings. V. positive or negative.

Number 2 Table 3.5) I13 (17) II 14 11 20 (1) 14 III N V VI VII (5) M/D 5 -124 Note: Ranges are given in parentheses. and a 101% increase occurred as cantilcver length increased from 7 mm to 20 mm. IS. highest bone levcl strains were recorded in the M/D direction (Table 4). A 55% increase in strain occurred as cantilever length increased from 7 mm to 14 mm. Abbreviations: SD. strain direction. Framework Microstrain (p)at Distal Abutment Recording Site During Opposite-Side I m d i n g Bone Level Strain increased from 7 mm to 14 mm. the M/D strains were consistent for each cantilever length regardless of the abutmcnt arrangement and were always tensile (+) (Fig 7). Volume 2. As with the framework. Compared with M/D framework microstrain. M/D strain at the terminal abutment on the framework did not vary with arrangement. Therefore. in contrast to framework strain. and no consistent trends were noted (Fig 8). WII IX 55 ( 7) 78 199 (28) 302 (19) -244 (26) -121 (37) -588 (26) XII XIII XN . Bone 1. A 30% increase occurred as cantilever length increased from 14 mm to 20 mm. Table 4. and a 386%increase occurred as cantilever length increased from 7 mm to 20 mm. Microstrains recorded at the terminal framework abutment during opposite-side loading were negligible (Table 3). F/I.rvrl Microstrain (p) at Distal Ahiitrnrnt Recording Sitr During Same-Side Loading Arrangement LS SD (nim) F/L 5 F/L F/L The mean values for M/D microstrain for all cantilever lengths at the terminal abutment bone level site during same side loading are listed in Table 7.97 June 1993. A 55% increase occurred as cantilever length increased from 14 mm to 20 mm. M/L) microstrain at the simulated bone level distal to the terminal fixture varied with abutment arrangement and was compressive (-) (Fig 9). However. In addition. only with cantilcver length. loading site (cantilever lmgth). microstrain I X XI 6 32 (4) i. F/L framework microstrains were comparatively small.

terminal abutment recording site. Ed. In contrast to the framework. percent of rriicyostrain iticrrase from 7 mni to 20 m m = 386%. It should be noted that the trends in the present studywere only Discussion The type of strain recorded (tensile or compressive) is a function of gauge orientation as shown by Iturregui et a19and Glantz et a1. strain direction. 20 m m . tion. In general. and XIII (Fig 9) and for arrangements XI and Xm (Fig 10).98 Ei:aluation ofStmin Table 5.Glantz et all0also showed a n increase in framework stress immediately distal to the terminal abutment as cantilever length increased.’ V VI VII I/II IX X XI XI/ A’III XIV Note: Ranges arc givrn in parrnthrw?. Although direction of strain was determined. bone level microstrain increased as the number of inactive abutments adjacent to the terminal abutment increased.I0Therefore. conclusions regarding the overall nature of strain on the experimental model must consider the gauge loca- Table 6. the primary focus of this study was thc change in relatiw magnitude of strain as cantilever length and abutment arrangement were varied. Arrangements with three consecutive inactive abutments (XI and XIV) produced the greatest increases in M/D microstrain (Fig 11). These arrangerneiits contained two or three inactive abutments adjacent to the terminal recording site. opposite-side loading produced significant levels of hf/D niicrostrain distal to the terminal fixture on the simulated bone surface (Fig 11). percent of microstrain increase from 1 1 rnm to ‘LO m m = 55%. 0. ARRANGEMENT Figure 7. increases in microstrain wcrc seen for arrangcmcnts X. 0 . Bone Level Microstrain (be) Rodriguez et a1 at Distal Abutment Recording Sitc During Opposite-Side Loadinc ilrrangernent SD I I S (mm) II III I?. M/D framework microstrain ( ~ L versus E ) abutm r n t a-1 angement. During same-side loading. LS. 11 mm. but was tcnsile (+) and smaller in magnitude (Fig 10). loading site (cantilever length) also varied with abutment arrangement. aarne-side loading. Framework Strain Framework strain distal to the terminal abutment increased more when the cantilever length was increased from 7 m m to 14 m m (213%) than when cantilever length was increased from 14 rnni to 20 m m (55%). Mean and Prrrmtage Incrrasr of M/D Framework hlicrostrain With Cantilever Length Cantzlraer Lxngth Mean i2hrostrazn (pE) 7 63 197 14 20 306 Note: Percent uf micrustrain incrrase from 7 nim to 14 m m = 213%. XI. Abbrevhions: SD. 7 mm.

percent of microstrain increase from 14 mm to 20 mm = 30%. The results of' this study indicated that cantilever lengths greater than 7 mm but less than 14 mm may produce the largest increase in strain immediately distal to the terminal abutmcnt and that cantilever lengths exceeding 15 rnm may not increase strain as much as theorized. sarne-side loading. framework microstrain (pe) versus abut- Figure 9. tcrmiiial abutment recording site. cvhilc bending at the site of strain gauge attachment may have increased more as cantilever length was increased from 7 mm to 14 mm than f'rom 14 mni to 20 nim.7 mm. 0. 175%) than when increasing from the 14 m m to the 20 mm loading site (11 mm to 17 mm. 14 mm. same-side loading. terminal abutment recording site. B. 20 rnm. ment ai rangernrnt. percent of microstrain increase from 7 mm to 20 mm = &ole: IOl% ARRANGEMENT Figure 10. U. Thcrefore.i -5w 454 ARRANGEMENT ARRANGEMENT Figure 8. 1. 300275 - 250225- Table 7. N u d m 2 I I . 14 inm. However." who showed a decrease in framework strain 7 mm distal to the terminal abutment as the number of supporting implant abutments decreased. terminal abutment recording site. nim loading site resulted in a greater pcrcentage increase in cantilever length from the strain gauge (4 mm to 11 mm. The ability to record strain in all directions and at multiple locations around the terminal fixture would be extremely difficult. The extremely rigid framework used in this invcstigation may have re- a. 20 mm. increasing cantilever loading from the 7 mm to the 14. 20 mm. Mean and Percentage Increase of M/D Bone Level Microstrain With Cantilever Length Cantiher Length Mean Mimitrain (. a.1 nirn. P/L bone level microstrain (KE) versiis abutment arrangement. F/I. M/D bone level microstrain ( ~ L versu? E) abut- ment arrangement. 7 mm. This can be partially explained by the fact that the M / D grid of the terminal abutmcnt strain gauge was only 4 mm anterior to the 7 mm loading site. 55%). for thc primary direction of strain (M/D) during a load perpendicular to the cantilever segment. 7 mm. but may changc thc rcsults stated above. 0. increascd flexure of the distal portion of the cantilevcr scgment ~ u l not d have been recorded by the terminal abutment strain gauge. Davis et a1 reported obvious bending of the framework used in their study.99 June 199. bending at points further distal from the strain gauge along the cantilever segment may have occurred. Volume 2.3. .u$ 5 14 164 254 20 330 Percent of niicrostrain increase from 7 mm to 14 mm = 55%. Also. M/D framework strain was consistent for each cantilever length (Fig 7). same-side loading. These results are in contrast to those of Davis et al. Therefore. a. Regardless of the abutment arrangement. 8 . a.

The relatively equal framework microstrain. However. In addition to gauge location as discussed with framework strain. when transmitted to the simulated bone. . M/D microstrain was greatest when two or Rodriguezet a1 three acljacent inactive abutments existed (arrangements X. IX and XII) or three nonadjacent inactive abutments (arrangement XIV) (Fig 9). it seems that with regard to minimizing bone stress levels. This design was similar to the ideal implant arrangement described by Rangert et al.100 Eiialuation ofstrain -'O0 I 1 s f i 4 70 aM) s p4 ' -50 2 4 30 -20 -10 ' I n m i v Y v i v ~ ~ v m i x x x r x n x m x m ARRANGEMENT Figure 11. The magnitude of the strains recorded at the terminal bone level site was the highest observed in this study. a greater mesial stress transfer may have occurred within the resin as compared with the rratnework as cantilever length increased. This could be caused by less resin microflexure with more closely spaced implants and a more equal stress distribution. the terminal implant fixture. whereas arrangements with three nonconsecutive inactive abutments (arrangements XII and XIH) produced unremarkable changes. M/D bone level microstrain ( p ~ versus ) abutment arrangrrnent. the archform used in this study provided a straight-line relationship between the cantilever segment. B. 20 mm. Angular loading of implant fixtures was also shown to produce higher bone stress patterns by Clelland et all4 and Wylie et Therefore. A similar trend was shown in the F/L direction for abutment arrangements XI and Xm. 7 mm. The presence of three consecutive inactive abutment sites (arrangements XI and XIV) produced si<gnificantincreases in M/D microstrain (Fig 1 l). and the implant fixture immediately anterior to the terminal abutment (Fig 1). anteriorposterior spread as well as interabutment distances (n. microstrain at the simulated bone level distal to the terminal fixture varied with abutment arrangement.5The bone level microstrain recorded in this investigation supports their theory that a straight-line relationship between the abutment adjacent to the terminal abutment and the cantilever segment r ill decrease terminal abutment stress during cantilever loading. microstrain recorded while loading on the same side that the strain gauges were attached to was higher than during opposite-side loading. sulted in the lack of influence abutment number or arrangement had on framework microstrain distal to the terminal abutment. oppositr-sidr loading. This is in agreement with the findings ofJemt et all2and Schwartzman et al. Theoretically. B. abutment arrangements XI and XIV showed a decreased anterior-posterior span as compared with abutment arrangements XII and XUI. In general. respectively (Fig 10). 14 mm. increases the angular loading of the abutment-fixture complex. Also. Rangert et al' predicted that bending moments induced by this type of abutment arrangement would increase stress transmission through the prosthetic components to the bone arid that damaging stress gradients may build up in the bone surrounding the implant fixtures. 0. the decreased anterior-posterior span.l3 They found that vertical loading of the distal cantilever caused the highest bone stresses to develop at the closest implant fixture. Also. produced less terminal abutment strain when there was a shorter distance between the terminal implant and the adjacent active implant fixture. terminal abutment recording site. XI. being analogous to a remote site loading of linearly arranged implant fixtures. mean bone l e d microstrain was much higher in magnitude than mean framework microstrain during 7 mm cantilever loading (63 FE versus 164 P E ) (Tables 6 and 7). Opposite-side loading presented some interesting trends in bone level microstrain distal to the terminal abutment. The high levels of microstrain recorded distal to the terminal fixture on the simulated bone are consistent with the findings of Schwartzmann et aI.13 Bone Lmel Strain Due probably to greater resin microflexure. In contrast to framework microstrain. Xm) followed by arrangements with one adjacent inactive abutment VIn. The variation in microstrain was rclated to the number of inactive abutment sites adjacent to the terminal fixture. due most likely to increased resin microflexure as described above. which had three and two adjacent inactive abutments. mean percentage increases of bone level microstrain with increasing cantilever length were less than those recorded on the framework (Tables 6 and 7).

Skalak K: Biomechanical considerations in osseointegrated prostlirses. and ( 3 ) To reduce angular loading of implant components. In addition.8 x lo3 MN/m2. Brunski J: Hiomaterials and biomechanics in dcntal implant design.49:843-848 8.17Because bone is not a homogenous material. Int J Oral Maxillofac Irnplants 1988. Zarh G. Taylor and Bagman4stated that cantilever extension should not cxceed 20 mm if five or six abutments are used and should not cxceed 15 mm if four abutments are incorporated.J Prosthet Dent 1988. IL. cantilever lengths of 7 mm to 15 mm for mandibular fixed implant prostheses are considered to be relatively Brsnemark et all recommended a length of two to three premolars. pp 2244 5. especially immediately adjaccnt to the terminal implant.1 1 x lo2h. In the literature. an increased anterior-posterior span of implant fixtures decreased the bone level strain distal to the terminal abutment. Brsnemark I. This should minimize stress transmission to the bonc around the terminal implant fixture.IN/m2). Scientific research aimed at evaluating the response of prosthetic components to functional loading are few. while limiting maxillary cantilevers to 6 to 8 mm because of poorer bone quality. A decreased interabutment distance between the terminal abutment and its adjacent abutment produced the lowest level of simulated bone microstrain at the terminal abutment site. References 1. English C: The critical A-Pspread. Quintrssenre. Thercfore. Thercfore. a logical surgical protocol would involve thc placement of the terminal implant fixtures first as close as possible to the mental foramen on each side. The results of this study suggest the following conclusions: ( I ) An optimum biomcchanical environment should exist when planning to incorporate cantilevers longer than 7 mm. This in vitro study was conducted to evaluate the strain generated within an implant prosthesis and at a simulated bone surface during functional cantilever loading.16This falls between the estimated moduli of elasticity for compact bone (1. I B U . The placement of these implants as far distal as possible is the most important factor in maximizing the potential anterior-posterior distribution of the remaining implants. mandible. Adell R. He recommended limiting cantilever extension to one and one-halftimes the anteriorposterior span when five fixtures are present in the Thc biomcchanical forces generated during function with a fixed implant prosthesis may have significant effects on the longelit). The polymethyl methacrylate resin used to simulate the human mandible in this investigation had an approximate modulus of elasticity of 3. while the softer. Int J Oral Maxillofar Irnplants 1989. 1985.10387-416 3. cantilever lengths exceeding 7 mm should be a p proached cautiously. IL. or when a decreased anterior-posterior arrangement is present. The remaining alveolar space can be equally divided among three or four implant sites while placing the medial implant fixture(s) as far anteriorly as the prosthetic setup will allow. EnglishGbased his recommendation of acceptablc cantilever length on the anterior-posterior span of implant fixtures. of the prosthesis. Cantilever increases beyond 7 mm caused the largest increases in both framework and bone level microstrain in this study. Rockler B. Rangert ct a15 reconimended I5 mm to 20 mm in the mandible. Albrektsson T: A multiccntcr rrport o r i osseointegrated oral implants.42 x 10' hfN/m2) and cancellous bone (2. Albrcktsson 'E Tissue Integrated Prostheses. Clinical Implications Conclusions The results of this study suggest guidelines for implant placement and framework design that may decrease the biomechanical forces transmitted to an implant-supported prosthesis and the underlying bone. Jorneus L: Forces and moments on Brinemark Implants. Number 2 I may be more important than simply the number of supporting abutments. Chicago. maximum anterior-posterior placement of implant fixtures should be incorporat cd. Implant Sac 1990. when long interabutment spans exist. (2) Ekcessive interabutment distances immediately adjaccnt to the terminal fixtures should be avoided. 117- I28 2.60:75-84 4.3:85-97 9. Quintessencc. Volume 2. for the edentulous mandible. Taylor R.1:2-3 7. predictions of' stress magnitude and stress transmission in thc human mandible based on the results of this study must be done with caution. Iturrcgui J: Evaluation of three impression techniques for . Lekholm V.J P r o s h t Dent 1983. Jemt T. ed 2. IntJ Oral Surg 1981.4: 24 1-247 6. Chicago. more porous bone in the maxilla should not support cantilevers exceeding 10 mm. pp 51-70. et al: A 15 year study of osseointegrated implants in the treatment of the edentulous jaw. Bergman G: Laboratory Techniques for the BrBriemark system. Karigert B.101 June 1993.

70:460 1.70459 15. Thompson V: 11two dimensional stress analysi. MO. Craig K: Restorative Dental Materials (rd 8).199I 10. 1989. Master’s Thesis. Int J Oral Maxillofac Implants 1991. rt al: In vivu load measurements on osseointegrated implants wpporting fixrd or removable prosthesis: A comparative pilot study. Acta Oduritol Scarid 1984. Glantz P. Clelland N. 11. ct al: Effect of maxillary h t u r e location and angulation on load transfer (abstract 1547). Alrxandridis C. IA. pp 67-75 17. Jcmt T. Nyman S. et al: O n functional strain in fixed mandibular reconstructions. Yang H..An in vivo study. Mito R. Goehring D: Photoelastic stress comparison o f anglcd abutmrnts lor a n implant (abstract 15. The effect of varying the number o f supporting abutments.6:4 13-417 13. osseointegrated oral implants.s: 197-201 12. Cal-lsson L. ChaoY Studies on frameworks for osseointep a t e d prusthesis: Part I.. Caputo A.42:269-276 I 1. Iowa City. et al: Load transfer b) Rodriguez et a1 multiple implants iindcr mrioiis prosthetic drvices (abstract 1549). .J Dent Res 1991. Davis D.JDent Kes 1991. IntJ Prosthod 1991. Gilat A. Schwarkman B. Int J Oral Maxillofac Implants 1988.1:416424 . Mosby.1. Wylir R Caputo A.: compaiing fixrd prosttidontic approaches to t tie tilted molar abutment. Strandman E.18).102 ELIaluahon ofstrait. University of Iowa.70:459 IF. Zarb G.J Dcnt Kcs 1991. St Louis. Bass A.