The purpose of this study was to investigate the influences of bone quality and implant size on the maximum equivalent elastic strain (MES) in peri-implant bone using finite element (FE) analysis, and to minimize implant size via optimized calculation based on MES. Three-dimensional FE models consisting of a mandible and a titanium implant with a superstructure were constructed and applied a vertical load or an oblique load of 60N. We investigated the effects of four variables: the thickness of the cortical bone (C), Young's modulus of the trabecular bone (T), and the diameter (D) and length (L) of the implant. According to the variables determined using Latin hypercube sampling, 500 FE models were constructed and analyzed under each of the loads following the construction of response surfaces with the MES as a response value. D and L were minimized by optimized calculation with the MES limited to the physiological limit with reference to the mechanostat theory. The MES was significantly influenced by D more than L, and could be restricted to the physiological limit unless both C and T were small. Larger MES than physiological limit was observed around the bottom of implants. From the viewpoint of the mechanostat theory, we calculated minimum size of implants according to the bone quality. However, the results should be verified with more detailed FE models made using CT data, animal studies and clinical prognoses.

The present study compared the clinical prognosis of double crown-retained removable dental prostheses (D-DRPs) with that of clasp-retained removable dental prostheses (C-RDPs). Clinical records of 201 patients who had received 52 D-RDPs with 144 abutment teeth (D-teeth) and 199 C-RDPs with 399 abutment teeth (C-teeth) at the Prosthetic Dentistry Clinic in Hokkaido University Hospital between April 2005 and June 2015 were analyzed. Survival and complication probabilities of the two types of prostheses and abutment teeth were evaluated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was used to determine the impact of covariates on abutment teeth survival and complications such as gender, age, type of retainer, Eichner classification, jaw, type of tooth, endodontic therapy performed, type of edentulous space, and presence of opposing teeth. Statistical analysis showed no significant differences between the two types of prostheses in terms of prostheses survival, prostheses complication, and abutment teeth survival. However, a significant difference was observed for complications of abutment teeth. Decementation was the most frequent cause of failure, which occurred in 76.9% of D-teeth and 28.3% of C-teeth. Patient's age, jaw, endodontic therapy performed, and type of edentulous space affected the survival of abutment teeth, whereas the type of retainer and edentulous space affected complications of abutment teeth. The prognosis of both types of prostheses was considered to be acceptable. Although D-RDP had lower complication-free rates for abutment teeth, most of the observed complications were decementation, which was considered to be reparable.

Background: The purpose of this study was to investigate the influence of occlusal forces (the contractile force of masticatory muscles) exerted during occlusal adjustment on the distribution of the forces among teeth, implants, and temporomandibular joints (TMJs) in intercuspal clenching in cases with bilateral missing molars and premolars by using finite element analysis. Methods: A three-dimensional finite element model of the mandible with eight implants in the premolar and molar regions was constructed. Linearly elastic material properties were defined for all elements except the periodontal ligament, which was defined as nonlinearly elastic. The TMJs and antagonists were simplified and replaced with nonlinear springs. Antagonists were assumed to be natural teeth or implants and had two- or three-stage displaceability. We constructed finite element (FE) models in which occlusal adjustment with three kinds of occlusal force (40 N as a light bite, 200 N as a hard bite, and 400 N as a maximum biting force) was performed. The clearance by occlusal adjustment was decided beforehand with a trial-and-error method so that the occlusal forces were distributed similarly to the distribution of the natural dentition. Each model was evaluated under loads of 40, 100, 200, 400, and 800 N to determine the distribution of occlusal forces on the teeth and implants. Results: The occlusal forces were concentrated on the most posterior implants while the load was larger, and the percentage of bearing force at the TMJ was small, and vice versa. Conclusions: Maximum biting force was better for occlusal adjustment to prevent overloading of the most posterior implant.

Dental implants are frequently applied to unilateral defects in the mandible. However, implant placement in the molar region of the mandible can be difficult due to anatomical structure. The aim of this study was to evaluate the distribution of occlusal force in a mandibular shortened dental arch (SDA) with implants. Three-dimensional finite element (FE) models of the mandible with varying numbers of teeth and implants were constructed. Models Im6 and Im67 contained one and two implants in the defect of the left molar region, respectively. Models Im456 and Im4567 contained three and four implants in the defect of the left premolar and molar regions, respectively. Model MT67 contained a defect in the molar region with no implant placed. Model MT7 represented natural dentition without a left second molar, as a control. Modification of the condition of occlusal contacts assuming the intercuspal position was performed before analysis under load 400 N; therefore, the load condition as total force on the occlusal surface was 400 N. FE analyses were subsequently performed under load conditions of loads 100, 200, and 800 N. The distribution of reaction forces on the occlusal surface and the mandibular condyle was investigated. Force distribution in models Im67 and Im4567 appeared to be symmetrical under all load conditions. Occlusal force distribution in models Im6 and Im456 was similar to that in model MT7. However, the occlusal force at the second premolars on the defect side in those models was larger under loads 100 and 200 N. Conversely, the occlusal force on the first molars was much larger than that in model MT7 under load 800 N. Within the limitations of this theoretical study, we demonstrated that restoration with the same number of implants as missing teeth will show almost symmetric occlusal force distribution, and it will produce less biomechanically stress for a unilateral defect of the mandible. However, if restoration of a missing second molar with an implant is impossible or difficult, then an SDA with implants may also be acceptable except for individuals with severe bruxism.