Clin Oral Impl Res 2000: 11: 465–475 Copyright C Munksgaard 2000

Printed in Denmark ¡ All rights reserved

ISSN 0905-7161

Magnitude and distribution of occlusal forces

on oral implants supporting fixed prostheses: an
in vivo study
Duyck J, Van Oosterwyck H, Vander Sloten J, De Cooman M, Puers R, Joke Duyck1,
Naert I. Magnitude and distribution of occlusal forces on oral implants Hans Van Oosterwyck2,
supporting fixed prostheses: an in vivo study. Jos Vander Sloten2,
Clin Oral Impl Res 2000: 11: 465–475. C Munksgaard 2000. Michel De Cooman3,
Robert Puers3, Ignace Naert1
1
Department of Prosthetic Dentistry/
BIOMAT research group, 2Department of
Since loading is increasingly believed to be a determining factor in the
Mechanics – Division of Biomechanics
treatment outcome with oral implants, there is a need to expand the and Engineering Design, 3Department of
knowledge related to the biomechanics of oral implants. The aim of this Electrotechnics – ESAT-MICAS, Catholic
study is to gain insight in the distribution and magnitude of occlusal forces University Leuven, Belgium
on oral implants carrying fixed prostheses. This is done by in vivo quanti-
fication and qualification of these forces, which implies that not only the
magnitude of the load but also its type (axial force or bending moment)
will be registered. A total of 13 patients with an implant supported fixed Key words: oral implants – fixed
full prosthesis were selected. Occlusal forces on the supporting implants prosthesis – biomechanics – strain
were quantified and qualified during controlled load application of 50 gauges – in vivo
N on several positions along the occlusal surface of the prostheses and
during maximal biting in maximal occlusion by use of strain gauged abut- Prof. I.E. Naert, Head, Department of
ments. The test was conducted when the prostheses were supported by all Prosthetic Dentistry, BIOMAT Research
(5 or 6) implants and was repeated when the prostheses were supported Group, Catholic University Leuven,
U.Z. St Raphaël, Kapucijnenvoer 33,
by 4 and by 3 implants only. Despite considerable inter-individual vari-
B-3000 Leuven, Belgium
ation, clear differences in implant loading between these test conditions Tel.: π32 16 332438
were seen. Loading of the extension parts of the prostheses caused a hin- Fax: π32 16 332309
ging effect which induced considerable compressive forces on the im- e-mail:
plants closest to the place of load application and lower compressive or Ignace.Naert/med.kuleuven.ac.be
tensile forces on other implants. On average, higher forces were observed
with a decreasing number of supporting implants. Bending moments were Accepted for publication 20 September
highest when 3 implants only were used. 1999

Since osseointegration was introduced as a pri-
mary demand for oral implant success, fixed pros-
theses supported by osseointegrated implants may
be regarded as a reliable treatment alternative (Ad-
ell et al. 1981; Lindquist et al. 1987, 1996; Al-
brektsson 1988; Haraldson & Zarb 1988; Lund-
qvist & Haraldson 1992; Naert et al. 1992). De-
spite the favourable long-term success rates,
success cannot be guaranteed. Some animal studies
(Becker et al. 1990; Lindhe et al. 1992) focused on
peri-implant infection as a possible cause for im-
plant failure. Based on in vitro (Smedberg et al.
1996), animal (Hoshaw et al. 1994; Isidor 1996,
1997; Barbier & Schepers 1997), and human
(Glantz et al. 1993; Mericske-Stern et al. 1996)
studies, there is a growing belief that implant fail-
ure might be caused by a disequilibrium of forces
acting on the oral implants (Esposito et al. 1998).
Although an adaptive remodelling response is ob-
served around oral implants, the biomechanical as-
pects of these processes remain uncertain (Hoshaw
et al. 1994). A first essential step towards the in-
sight in the forces which are transferred to the
bone and which therefore affect the latter, is to
quantify and qualify the forces applied on oral im-
plants supporting an oral prosthesis. In addition

465
Duyck et al.
Fig. 1. Fixed full prosthesis supported by strain gauged abut-
ments.
to this, finite element analyses based on individual
CT-Scan data and to some extent animal experi-
mental studies, can provide information about the
way these forces will be transferred to and affect
the surrounding bone. By in vivo registration of the
axial forces and bending moments that are induced
on the implants during controlled load application
and during clenching, this study contributes to the
first step.
Materials and methods
Patients
A total of 13 patients with an implant supported
fixed prosthesis in the fully edentulous mandible
(9) or maxilla (4) were selected. In all patients
Brånemark implants (Nobel Biocare, Sweden) were
installed and 5.5- or 7-mm standard abutments
were connected to the implants to support the
prostheses. All original abutments were replaced
by strain gauged abutments of the same dimen-
sions to allow load registration as described below
(Fig 1). All but one prostheses were supported by
6 oral implants. The remaining prosthesis was sup-
ported by 5 implants. Moreover, in 2 patients it
was only possible to measure the load on 5 of the 6
supporting implants because there was not enough
inter-implant space to replace all abutments by the
strain gauged abutments which are slightly broader
due to the attached strain gauges. In the antagon-
istic jaw 8 and 4 of the patients were provided with
a fixed full implant supported prosthesis or a re-
movable denture respectively, one had a natural
dentition. All patients demonstrated a stable oc-
clusion. The mean age of the patients was 58 years
(range: 41 to 75) and they were functioning suc-
cessfully with their oral prostheses since 4.9 years
on average (range: 0.5 to 12.75). Over this period,
3 fixed prostheses needed to be repaired because
466
of fracture of a resin facet. No further mechanical
complications occurred and none of the implants
became mobile. The mean marginal bone loss –
rated mesially and distally on retro-alveolar radio-
graphs that were placed parallel to the implant
body using a long-cone device – averaged 0.15 mm
(SEM: 0.22 mm), the first year included.
Measuring device
Standard 5.5- and 7-mm abutments were equipped
with three strain gauges (Type FLG-02–11 of
TML; Tokyo Sokki Kenkyujo Co., Ltd.; Resis-
tance: 120∫0.3 W; Gauge factor: 2.05∫1%) each,
120æ apart. These strain gauges were adapted to
the abutment surface to register deformations of
the latter. Each strain gauge was wired separately
into a Wheatstone bridge and when sufficiently
balanced, the output voltage of the bridge is pro-
portional to the resistance change of the strain
gauge, which is in turn proportional to the strain
in the abutment. A computer program under Win-
dows has been developed to process the data and
to transform these data into a numerical represen-
tation of the axial force and 2 bending moments
Fig. 2. Schematical illustration of a fixed full prosthesis sup-
ported by 6 oral implants. The numbers indicate the positions
along the occlusal surfaces of the prostheses where 50 Newton
was applied: 1) above the distal extension, left quadrant; 2)
above the distal implant, left quadrant; 3) above the medial
implant, left quadrant; 4) above the mesial implant, left quad-
rant; 5) in between the 2 mesial implants (frontal extension); 6)
above the mesial implant, right quadrant; 7) above the medial
implant, right quadrant; 8) above the distal implant, right
quadrant; and 9) above the distal extension, right quadrant.
The abutments in position 3 and 7 are left out when the pros-
thesis is supported by only 4 implants. One additional mesial
implant (in position 4 or 6) is excluded when the prosthesis is
supported by only 3 implants.
 Occlusal forces on oral implants supporting fixed prostheses

Fig. 3. (a) Axial force induced on each of the 6 implants supporting 1 particular prosthesis during controlled load application of
50 N on the 9 indicated places along the occlusal surface. (b) Bending moment induced on each of the 6 implants supporting 1
particular prosthesis during controlled load application of 50 N on the 9 indicated places along the occlusal surface.

around perpendicular axes. By use of the bending

moments around both perpendicular axes, the
total bending moment on the abutments could be
calculated (Duyck et al. 1999). To apply measur-
able loads at the level of the occlusion, a miniature
bite fork was used (Fløystrand et al. 1982). When
the patient bit on the fork, the forces were regis-
tered both on the occlusal and the abutment level.
This allowed excluding any influence of the
existing occlusal arrangement and articulation be-
tween patients on the load registration.
Test conditions
To create situations, which can be compared with
one another, the miniature bite fork was used to
apply controllable loads on several positions on
the prostheses. The bite fork was placed at defined
consecutive positions along the occlusal surface of
the prostheses. The positions are indicated in Fig
2. Because there was not enough space to measure
between the 2 mesial implants in 2 of the pros-
theses, no measurements could be performed while

467
Duyck et al.

loading those prostheses on position 5. Except for

Fig. 4. Average (SEM) axial force and bending moment per
abutment for the 3 test conditions (6/5, 4, and 3 supporting
implants).
one, all prostheses had distal extensions of one
cantilever unit. Because these cantilever units were
lacking in one prosthesis, measurements when
loading on positions 1 and 9 were impossible. The
patients could control the applied force on the bite
fork by means of visual feedback and they were
asked to bite with a force of 50 N. The bite fork
forces and the forces on the abutments were re-
corded simultaneously. The registrations of the
forces on the abutments were collected at the same
time point as when the patient bit approximately
50 N. Each strain gauge value was a mean of 20
consecutive registrations, representing 0.4 s of

Fig. 5. (a) Average (SEM) axial force on the abutments during loading of the ipsi-lateral distal extension with 50 N for the 3 test
conditions (6/5, 4, and 3 supporting implants). (b) Average (SEM) bending moment on the abutments during loading of the ipsi-
lateral distal extension with 50 N for the 3 test conditions (6/5, 4, and 3 supporting implants).

468
 Occlusal forces on oral implants supporting fixed prostheses
registration time in total. A linear relationship be-
tween applied and transferred forces was assumed,
allowing for a recalculation of the forces on the
bite fork and on the abutments to exactly 50 N
to make comparisons possible. In addition, load
registrations were performed during maximal
biting in maximal occlusion (clenching). The used
strain gauge values are a mean of 10 consecutive
registrations, representing 0.2 s of registration
time.
All tests were performed when the prostheses
were supported by all 5/6 implants and were re-
peated when the prostheses were only supported
by 4 and 3 implants respectively. In case the pros-
theses were only supported by 4 implants, the two
abutments connected on the implants positioned
in the middle of each quadrant (medial implants)
were removed. In case the prostheses were only
supported by 3 implants, an additional mesial
abutment was removed (see Fig. 2).
To get an idea of the influence of the antagonistic
teeth or restoration on the load distribution among
the implants, a comparison was made between the
fixed prostheses in the mandible. Five out of the 9
mandibular implant supported prostheses antagon-
ized a natural dentition or a fixed restoration, while
the remaining 4 occluded with a maxillar removable
full denture. The load distribution during clenching Fig. 6. (a) Average (SEM) axial force on the abutments during
in both groups was compared. loading in between the 2 mesial implants (frontal extension)
with 50 N for the 3 test conditions (6/5, 4, and 3 supporting
implants). (b) Average (SEM) bending moment on the abut-
Statistical analysis ments during loading in between the 2 mesial implants (frontal
extension) with 50 N for the 3 test conditions (6/5, 4, and 3
The data were compared by means of a linear supporting implants).
mixed model (Verbeke and Molenberghs 1997)
which corrects for the fact that several dependent
measurements were done. Tukey’s method was used
to correct the P-values for the paired comparisons (P∞0.0001) or 3 (P∞0.002) implants. The differ-
in order to correct for multiple testing. The analy- ence in axial force between 4 and 3 supporting im-
ses were performed using the SAS-program (SAS/ plants is not statistically significant. The bending
STAT software: Changes and Enhancements moments on the other hand are significantly higher
trough Release 6.12, SAS Institute Inc., Cary, NC, with 3 supporting implants in comparison with 4
USA). The level of significance was set at 0.05 for or 5/6 supporting implants (P∞0.0001). The differ-
all tests. ence in bending moment between 4 and 5/6 sup-
porting implants is not statistically significant.
Fig. 5a,b depicts the average induced axial
Results forces and bending moments during loading of the
To get a better insight in the individual loading of ipsi-lateral distal extension with 50 N. These data
each of the implants, 1 patient, representative for comprise 2 tests per patient since each prosthesis
all others, is fully presented for the controlled load has 2 distal extensions. Regardless of the number
application (50 N). Fig. 3a,b represents the forces of supporting implants, the highest compressive
on all 6 supporting abutments for 1 particular pa- forces are recorded on the ipsi-distal implant
tient. The average axial forces and bending mo- (P∞0.0001) while tensile forces (negative axial
ments per abutment per test condition for the forces) are observed on the implants positioned
whole group during controlled load application of medially and mesially in each quadrant. The bend-
50 N are presented in Fig 4. The mean axial force ing moments on the ipsi-distal and ipsi-medial im-
is significantly lower when the prostheses are sup- plants do not differ significantly from each other,
ported by all implants in comparison with 4 but they are significantly higher than the bending

469
Duyck et al.

Fig. 7. (a) Average (SEM) axial force on the abutments during loading of the prostheses above the ipsi-medial implant with 50 N
for the 3 test conditions (6/5, 4, and 3 supporting implants). (b) Average (SEM) bending moment on the abutments during loading
of the prostheses above the ipsi-medial implant with 50 N for the 3 test conditions (6/5, 4, and 3 supporting implants).

moments on the other implants (P∞0.0008). The
loading conditions of the implants are also investi-
gated when loading the prosthesis in the middle
between the two mesial abutments (frontal exten-
sion). These data are presented in Fig. 6a,b. The
axial forces that are recorded on the mesial im-
plants are significantly higher than on the medial
(P∞0.02) and distal implants (P∞0.0001). Small
compressive and tensile forces are observed on the
medial and distal implants. The difference in axial
forces between the medial and mesial implants is
significant (P∞0.002). Nevertheless, the observed
axial forces in that particular loading situation are
not significantly dependent on the number of sup-
porting implants. The accompanying bending mo-
ments increase significantly (P∞0.0002) when the
prostheses are supported by only 3 implants in
comparison with 5/6 or 4 implants. Such a differ-
ence is not observed between 5/6 or 4 supporting
implants. There is no significant difference in
bending moment between the different implants.
Fig. 7a,b summarizes the results when loading the
prosthesis above the ipsi-medial implant. When all
implants support the prosthesis, the highest axial

470
 Occlusal forces on oral implants supporting fixed prostheses

(P∞0.02) implants. The average (SEM) maximal

axial force on the distal implants in case of 5/6, 4
and 3 supporting implants is 106.2 N (23.3 N),
136.2 N (31.5 N), and 165.8 N (33.9 N) which is
significantly higher than the medial and the mesial
implants (P∞0.02). This was not statistically sig-
nificant for the maximal bending moments.
Peak axial forces and bending moments on the
implants supporting the mandibular prostheses
during clenching were selected. The prostheses ant-
agonizing a natural dentition or a fixed restoration
were compared with those antagonizing a remov-
able maxillar denture. The mean (SEM) peak axial
forces and bending moments were calculated for the
distally, medially and mesially positioned implants
and presented in Fig. 9a,b. Despite the lack of statis-

Fig. 8. (a) Average (SEM) maximal axial force registered on the

abutments during maximal biting in maximal occlusion for the
3 test conditions (6/5, 4, and 3 supporting implants). (b) Aver-
age (SEM) maximal bending moment registered on the abut-
ments during maximal biting in maximal occlusion for the 3
test conditions (6/5, 4, and 3 supporting implants).

force is seen on the ipsi-medial implant, although

the difference with the ipsi-mesial implant is not
statistically significant. Comparable bending mo-
ments are observed on the ipsi-distal and ipsi-me-
dial implants, which are significantly higher
(P∞0.02) than on the other implants. The neigh-
bouring implants are subjected to significantly
higher axial forces (P∞0.02) when this ipsi-medial
abutment is dropped. Only minor forces are re-
corded on the implants at the contra-lateral side.
Those data comprise again 2 tests per patient since
the patients have 2 medial implants. When the
prosthesis is only supported by 3 implants, Fig.
7a,b suggests that the mesial implant is always po-
sitioned at the ipsi-lateral side. Nevertheless, the
mesial implant remains the same when loading
both medial implants, which implies that the me-
sial implant is located on the ipsi-lateral side in
only half of the tests.
To get a better view on the load distribution dur-
ing maximal biting in maximal occlusion, the
maximal axial forces and the maximal bending
Fig. 9. (a) Average (SEM) peak axial forces registered on the
moments registered on the abutments during the distal, medial and mesial abutments supporting a mandibular
test are analysed. The average values are presented fixed prosthesis occluding with a natural dentition/a fixed res-
in Fig. 8a,b. The maximal axial forces are not sig- toration (fixed) or a maxillar removable denture (removable)
nificantly different when varying the number of during maximal biting in maximal occlusion. (b) Average
supporting implants. The maximal bending mo- (SEM) peak bending moments registered on the distal, medial
and mesial abutments supporting a mandibular fixed prosthesis
ments on the other hand are significantly higher occluding with a natural dentition/a fixed restoration (fixed) or
when the prostheses are supported by only 3 im- a maxillar removable denture (removable) during maximal
plants in comparison with 4 (P∞0.003) or 5/6 biting in maximal occlusion.

471
Duyck et al.
tically significant differences between both groups,
there is a tendency for higher axial forces as well as
bending moments on the distally positioned im-
plants of the dentures wearers whereas the loads are
more evenly distributed in the other group.
Discussion
Fig. 3a,b clearly shows the variability of forces on
each of the supporting implants when loading the
prosthesis on different positions. It is obvious that
the load applied on one position is distributed to
several supporting implants through the prosthesis.
Interpretation of the results should be handled care-
fully because the distribution of forces seems to be
influenced by a variety of factors such as number,
spreading, and inclination of the implants, canti-
lever length, design and rigidity of the prosthetic
superstructure, bone quality, and functional jaw de-
formation (Skalak 1983; Weinberg 1993; Benzing et
al. 1995; Patterson et al. 1995; van Zyl et al. 1995;
McAlarney & Stavropoulos 1996; Sertgöz & Güv-
ener 1996; Hobkirk & Havthoulas 1998). It is for ex-
ample interesting to observe that when load is ap-
plied at position 6 (above the mesial implant in the
right quadrant), most of the load is transferred to
the neighbouring implants instead of to the implant
lying underneath the place of load application. This
can be explained by the fact that due to a certain
misfit of the superstructure, the prosthesis will not
be seated identical on all supporting abutments. If
there is a larger vertical misfit between the prosthesis
and a particular abutment in comparison with the
neighbouring abutments, the prosthesis will be
seated better on the neighbouring abutments.
Therefore, a load applied on the prosthesis will
more likely be transferred to those abutments with
the best fit and to those integrated in the bone with
highest density.
Loading the extension in the left quadrant (posi-
tion 1) of this particular prosthesis seems to have
a more distinct influence on the neighbouring im-
plants than the same load application on the ex-
tension in the right quadrant (position 9) does. It
is also striking that load application on position 8
(above the distal implant in the right quadrant)
seems to induce a lower overall load on the im-
plants than load application on other places does.
These observations are supposed to be the result of
a synergism and antagonism of several individual
factors as mentioned above.
Fig. 4 indicates that the mean load per implant
increases when the number of supporting implants
decreases. Nevertheless, the particular loads on the
individual implants should be taken into consider-
ation to gain insight in the way forces act on im-
plants supporting an oral prosthesis.
472
An interesting view on the data is given in Figs
5, 6, and 7 where the effect of a 50 N axial force
applied on a specific position is evaluated. Fig.
5a,b indicates what happens with the supporting
implants when the distal extension pontic of the
prosthesis at the ipsi-lateral side is loaded with 50
N. The distal implant needs to bear high compres-
sive forces and bending moments which are on av-
erage at least the double of the applied load due
to a cantilever effect. This is in accordance with
observations from previous studies where the
highest loads were observed on the distal implants
and their surrounding bone when loading a distal
cantilever (Skalak 1983; Haraldson & Zarb 1988;
Glantz et al. 1993; Benzing et al. 1995; Patterson
et al. 1995; Tashkandi et al. 1996; Assif et al. 1996).
Only minor forces are observed on the implants at
the contra-lateral side. Assuming a hinging effect
of the prosthesis, the negative axial forces acting
on the mesial implants – which can be interpreted
as tensile forces – are a logic observation and were
also observed in previous studies (Patterson et al.
1995; Assif et al. 1996). The magnitude of the
bending moments decreased with increasing dis-
tance to the point of load application. Fig. 6a,b
presents the load on the supporting implants when
the frontal extension of the prosthesis (in the
middle between the two mesial implants) is loaded
with 50 N. When the prosthesis is supported by all
implants, again a hinging effect is observed with
the highest compressive forces on the mesial im-
plant, less forces on the medial implants and small
tensile or compressive forces on the distal im-
plants. The loading conditions are rather similar
after the 2 medial implants are excluded, but when
there is only 1 mesial supporting implant, the situ-
ation seriously alters. Besides the compressive
forces on the mesial implants, also the bending
moments on all supporting implants increased sig-
nificantly when only 3 implants were present. The
foregoing suggests that spreading of implants as
well as the actual number of supporting implants
is of great importance. When loading the implants
positioned in the middle of each quadrant, loads
are well distributed along the other implants in the
ipsi-lateral quadrant whereas hardly any load is
transferred to the contra-lateral quadrant. Fig.
7a,b shows that when the prosthesis is carried by
5/6 implants, most of the load is carried by the
implant underneath the position of load appli-
cation (ipsi–medial). When implants are excluded,
there is a distinct increase of forces applied on the
neighbouring implants. The negative axial forces
on the distal implants in the contra-lateral quad-
rant suggest that a hinging-effect of the prosthesis
may occur.
As mentioned in the results, Fig. 8a,b presents
 Occlusal forces on oral implants supporting fixed prostheses
the average maximal axial force and the maximal
bending moment respectively, registered on the
abutments during maximal biting in maximal oc-
clusion. This gives an idea of which implants take
the highest loads. The figure shows that the maxi-
mal axial loads registered on the distal implants
are higher than those on the medial and mesial
implants are. Despite the lack of statistical signifi-
cance, Fig. 9a,b shows on average higher peak ax-
ial forces and bending moments on the distal im-
plants supporting a mandibular prosthesis antag-
onizing a removable denture in comparison with
those antagonizing a fixed restoration. The load
seems to be better distributed when the prosthesis
is antagonizing a natural dentition or a fixed res-
toration instead of a removable denture. This
corroborates the findings of Falk et al. (1989/1990)
and Lundgren et al. (1989) who observed increas-
ing local closing and chewing forces bilaterally in
the distal direction on mandibular implant-sup-
ported cross-arch prostheses occluding with maxil-
lary complete dentures. This was said to be caused
by the behaviour of the maxillary complete den-
ture during function. Probably the larger anterior
resiliency of the oral maxillary mucosa causes a
hinging of the denture basis, thereby transferring
more load onto the posterior area.
Although Tashkandi et al. (1996) indicated
higher loads on the distal implants with an increas-
ing cantilever length, Naert et al. (1992) could not
correlate marginal bone loss with the cantilever
length. Lindquist et al. (1988, 1996) observed even
more bone loss around mesially positioned im-
plants in comparison with distal implants carrying
a fixed full prosthesis. However, when only exten-
sion contact was present, thus leaving the anterior
area without contact, more implant failures and
bone loss were observed especially at the distally
positioned implants (Quirynen et al. 1992). There
is a tendency for an increased average load with a
decreasing number of implants which brings the
situation on 3 implants only at a higher risk for
(mechanical) failure, keeping the implant dimen-
sions the same. Nevertheless, its clinical relevance
towards the bone surrounding the implants needs
to be further investigated. Since a study of Bråne-
mark et al. (Brånemark et al. 1995) showed similar
survival rates for both implants and prostheses
when fixed prostheses were supported by 6 or 4
implants at the end of a 10-year observation
period, it is possible that the difference in loading
conditions between 6 or 4 supporting implants has
no clinical relevance at all. A recent paper (Bråne-
mark et al. 1999) even reports remarkably good
results when fixed full prostheses are mounted on
only 3 implants. In these cases, larger diameter im-
plants (5 mm) were used to avoid mechanical fail-
ure of the implants. More research is needed to
define more precisely the difference in loading con-
ditions according to the number of supporting im-
plants. In addition to that, finite element analyses
based on individualized CT-Scans derived from
humans are compulsory to further understand the
aetiology of failure of implants, especially to load-
ing. Such studies are underway.
Acknowledgements
This study was supported by the Research Fund of Research
Council K.U.Leuven (no. OT95/27) and the Fund for Scientific
Research, Flanders (no. G.0180.26). The authors would like to
thank Kris Bogaerts for the statistical analyses.
Résumé
Comme la charge s’avère de plus en plus être un facteur déter-
minant dans le résultat du traitement par implant dentaire, il
est nécessaire d’étendre notre connaissance de leur biomécani-
que. Le but de cette étude a été d’élargir nos connaissances en
ce qui concerne la répartition et la magnitude des forces occlu-
sales des implants dentaires portant des prothèses fixes. Ceci a
été effectué par quantification et qualification de ces forces in
vivo ce qui signifie que non seulement la magnitude de la charge
mais aussi son type (force axiale ou mouvement de pliage) ont
été enregistrés. Treize patients avec une prothèse complète fixe
sur implants ont été sélectionnés. Des forces occlusales sur les
implants ont été quantifiées et qualifiées durant les charges
contrôlées de 50 N sur différentes positions le long de la surface
occlusale des prothèses et durant le serrage maximum en occlu-
sion maximale en utilisant des jauges de force. Le test a été
effectué lorsque les prothèses étaient supportées par tous (cinq
ou six) les implants et a été répété lorsque les prothèses n’étaient
supportées que par quatre ou trois implants seulement. Malgré
une variation interindividuelle considérable, des différences
claires dans la charge imposée à l’implant entre ces différentes
conditions tests ont été mises en évidence. La charge des parties
en extension de ces prothèses causait un effet charnière qui ap-
portait des forces de compression considérables sur les implants
les plus proches de l’endroit où se trouvait l’application de la
charge, et des forces de compression ou de tension inférieures
sur les autres implants. En moyenne, des forces plus importan-
tes ont été observées avec un nombre réduit d’implants de sup-
port. Les moments de pliage les plus importants étaient pré-
sents lorsque seulement trois implants étaient utilisés.
Zusammenfassung
Seit immer mehr angenommen wird, dass die Belastung einen
entscheidenden Faktor beim Behandlungserfolg mit oralen Im-
plantaten darstellt, besteht ein Bedürfnis, das Wissen bezüglich
Biomechanik bei oralen Implantaten zu erweitern. Das Ziel die-
ser Studie ist es, Einsicht in die Verteilung und die Grösse von
okklusalen Kräften bei oralen Implantaten, welche festsitzende
Rekonstruktionen tragen, zu gewinnen. Dies wird getan durch
die in vivo Quantifikation und Qualifikation dieser Kräfte. Das
bedeutet, dass nicht nur die Grösse der Belastung, sondern
auch die Art der Kraft (Axiale Kraft oder Biegemoment) regi-
striert wird. Es wurden 13 Patienten mit implantatgetragenen
festsitzenden Totalprothesen ausgeẅahlt. Okklusale Kräfte bei
den Implantaten wurden während einer kontrollierten Kraftan-
wendung von 50 N und beim maximalen Zusammenbeissen in
der Zentrik an mehreren Stellen entlang der Okklusalflächen
der Rekonstruktionen mit Hilfe von Dehnmessstreifen in den
473
Duyck et al.
Prothetikzylindern quantifiziert und qualifiziert. Der Versuch
wurde durchgeführt, wenn die Rekonstruktion auf allen (5 oder
6) Implantaten verankert waren und wurde wiederholt, wenn
die Rekonstruktionen nur auf 4 oder 3 Implantaten befestigt
waren. Nebst beträchtlichen Unterschieden zwischen den ein-
zelnen Individuen konnten klare Unterschiede in der Belastung
der Implantate bei den verschiedenen Testbedingungen gesehen
werden. Die Belastung der Extensionen der Rekonstruktionen
bewirkte einen Hebeleffekt, welcher beträchtliche Krompres-
sionskräfte bei den Implantaten in unmittelbarer Nähe der Be-
lastung zur Folge hatte, während es bei den anderen Implanta-
ten zu geringerer Kompression oder zu Zugkräften kam. Im
Durchschnitt konnten mit abnehmender Anzahl von Befesti-
gungsimplantaten zunehmende Kräfte beobachtet werden. Die
Biegemomente waren am grössten, wenn nur 3 Implantate ver-
wendet wurden.
Resumen
Desde que se considera cada vez mas que la carga es un factor
determinante en los resultados terapéuticos con implantes ora-
les, existe la necesidad de expandir los conocimientos relaciona-
dos con la biomecánica de los implantes orales. La intención
de este estudio fue aumentar la comprensión en la distribución
y magnitud de las fuerzas oclusales en los implantes que sopor-
tan prótesis fijas. Esto se lleva a cabo por cuantificación y cuali-
ficación in vivo de estas fuerzas, lo que implica que no solo se
registrará la magnitud de la carga sino también su tipo (fuerza
axial o momento de torsión). Se seleccionaron 13 pacientes con
una prótesis completa fija implantosoportada. Se cuantificaron
y cualificaron las fuerzas oclusales en los implantes de soporte
durante la aplicación controlada de una carga de 50 N en dife-
rentes posiciones a lo largo de la superficie oclusal de la prótesis
y durante la mordida máxima en máxima oclusión por medio
del uso de pilares calibrados para tensión. El test se Ilevó acabo
cuando la prótesis estaba soportada por totos los implantes (5
ó 6) y se repitió cuando la prótesis estaba soportada por 4 y
por 3 implantes solamente. A pesar de la variación considerable
interindividual, se observaron clares diferencias en la carga del
implante entre estas condiciones de prueba. La carga de las
partes en extensión de la prótesis produjo un efecto de bisagra
que indujo fuerzas de compresión considerables en los implan-
tes más cercanos al lugar de aplicación de la carga y menores
fuerzas compresivas o tensiones en otros implantes. De media
se observaron mayores fuerzas con un número decreciente de
implantes de soporte. Los momentos de torsión fueron más
altos cuándo se usaron sólo tres implantes.
474
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