Effect of Implant Diameter and Bruxism on Biomechanical Performance in Maxillary All-on-4 Treatment: A 3D Finite Element Analysis.

PURPOSE: To examine the stress distribution in the maxillary All-on-4 treatment concept supported by implants of different diameters under two different loading forces using finite element analysis. MATERIALS AND METHODS: Two distinct All-on-4 designs were prepared in a fully edentulous maxilla, supported by 3.3- and 4.1-mm-diameter implants. Posterior implants were tilted distally, approximately 30 degrees to the occlusal plane, and anterior implants were placed axially. Bone, implant, and prosthetic components were modeled separately and were tightly connected to each other. Under two distinct loading conditions representing the occlusal forces of healthy and bruxist individuals, the stresses on peri-implant bone, implant, and prosthetic components were evaluated using finite element analysis. RESULTS: There were higher stresses on cortical bone than on trabecular bone. The stresses on bone and implant components were concentrated around the posterior implants, whereas stresses on the prosthesis were concentrated anteriorly. With increasing implant diameter, the stresses on trabecular bone, abutments, and crowns increased, whereas the stresses on cortical bone, implants, and frameworks decreased. Compressive stresses in the cortical bone and von Mises stresses in the frameworks exceeded the overload limit in both models under bruxist loading. CONCLUSION: The stresses on the cortical bone, implants, and frameworks were slightly higher in the model with 3.3-mm-diameter implants, whereas the stresses on the trabecular bone, abutments, and crowns were slightly higher in the model with 4.1-mm-diameter implants.