The Biomechanics of Force Distribution in Implant-Supported Prostheses

JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan
Copyrights 1997 Quinte
The Biomechanics of Force Distribution in Implant-Supported Prostheses

Lawrence A. Weinberg, DDS, MS
Force distribution with natural teeth depends on micromovement induced by the periodontal ligament. The location and cusp inclination of the tooth qualitatively alter the force pattern. Osseointegrated implants do not have micromovement associated with force distribution. Force distribution to the osseointegrated implant interface is completely different than with natural teeth. Alterations in tooth location and cusp inclination are suggested to limit implant overload. Force distribution in splinted natural teeth and osseointegrated prostheses are compared. The mechanism of interface force distribution and the consequences of poor interface fit are interrelated. The differential mobility of splinted natural teeth affects diagnosis and treatment. However, combining natural teeth with an osseointegrated prosthesis requires new design principles. (INT J ORAL MAXILLOFAC IMPLANTS 1993;8:19-31.)
Key words: differential mobility, force distribution, impact area, interface force distribution, micromovement, micron movement, modulus of elasticity
The biomechanics of force distribution in implant-supported prostheses is

qualitatively different than when natural teeth serve as abutments. The essential difference is caused by the periodontal ligament, which permits micromovements, compared to the osseointegrated implant, which has none. This article describes the principles of force distribution as applied to diagnosis and treatment of implant-supported prostheses.
Principles of Force Distribution

The character of force distribution between members of a system depends on the relative stiffness/deflection of each member1-3 (Weinberg R, personal communication). However, there is a paradox concerning the role of rigidity and deformation (flexibility) when comparing tooth-supported and multiple-implant-supported prostheses. There are structural differences between the two entities and the supporting medium (ie, periodontal ligament versus osseointegration), which are diametrically opposed physiologically. The former has the maximum flexibility of any portion of the system whereas the latter, by definition, has none. The prostheses of both systems are considered stiff. A fixed prosthesis is usually permanently cemented to the natural teeth, forming one stiff structural unit.
However, the vertical elements of each system have opposing characteristics. The implant-abutment-prosthesis interfaces introduce minute degrees of flexibility as the result of retaining screw deformation. These factors have a profound effect on the concepts of force distribution when systems are compared and introduce the risk of clinical failure when teeth and implants are combined in support of prosthesis without an understanding of these fundamental differences. Character of Force Distribution. A scientific analysis of force distribution is statistically indeterminate1 because of variable factors that prevent quantifying measurements. For instance, cortical and medullary bone have different elasticities.1 The attaching screws have much more deflection (flexibility) than the prosthesis framework. The relative intimacy of interface fit of the prosthesis to the abutments will alter force distribution.1 Cantilever force application and the geometric location of the fixtures further alter force distribution patterns. Force Distribution Analysis. Finite element analysis of fixture design (ie, computer mathematical models) has shed light on the distribution of force with various implant configurations.4 However, Brunski3 has pointed out the enormity of the problem when considering all of the variables involved in the evaluation of the in vivo total prosthesis-implant-bone system. In the absence of quantified force analysis, clinically pertinent estimates of force distribution in natural teeth and fixture-supported systems may be made1 with simplified models2,5 and/or simplified assumptions.6,7 Simplified approximation of force distribution is an essential first step in diagnosis and treatment planning; the following discussion is made within the parameter of these limitations.
Definitions
Macromovement. Movement of a tooth or prosthesis component more than 0.5 mm and easily observable. Micromovement. Movement of a tooth, prosthesis, or implant system component 0.1 to 0.5 mm and not readily observable but subject to measurement. Micron-movement. A term (coined here) to describe angstrom level (microscopic) movement below 100 m (less than 0.1 mm) that is not observable or subject to measurement in vivo by ordinary means.
Force Distribution With Natural Teeth

Because of micromovement permitted by the periodontal ligament, as well as the shape of the root itself, vertical occlusal force (O) produces a resultant line of force (F) that has its center of rotation (CR) located in the apical third area6,7 (Fig 1a). Impact Area. The impact area is the cuspal contact of opposing teeth (arrow, Fig 1a). The resultant line of force is always perpendicular to the impact area.6,7 Therefore, a cusp-to-fossa contact produces a vertical force, while a cusp-to-incline contact produces lateral forces. For instance, when a vertical force is applied to the
buccal cusp incline, the resultant line of force, perpendicular to that inclination, falls at a great distance (D) from the center or rotation of the tooth6,7 (Fig 1a). Torque. Lateral force is expressed as torque, which is the force multiplied by the perpendicular distance from the center or rotation (Fig 1a). As shown in Fig 1b, lateral force can be effectively diminished by reducing the cusp inclination of the impact area so the resultant line of force passes closer to the center of rotation of the tooth. Compressive and tensile forces are exerted on the periodontal ligament as the tooth exhibits micromovement about the center of rotation (Figs 1a and 1b). The length of the root significantly enhances the distribution of force to the alveolar bone.
Force Distribution With Implants

Bone Modulus of Elasticity. The modulus of elasticity of bone permits a degree of deflection measured in microns. (Titanium fixtures are more rigid than the investing bone.1) However, osseointegrated implants have no micromovement (such as that permitted by a periodontal ligament) sufficient enough to cause distribution of force equal to that of natural teeth. Torque. Because the lack of micromovement of implants, most of the force distribution is concentrated at the crest of the ridge.4 Vertical force on cylindrical implants would be concentrated at the apex, while threaded implants would produce crestal and apical force on the bone.4 Lateral forces in both designs would result in crestal force distribution.4 (A screw-type fixture is used in all illustrations for simplicity; however, the discussion applies to cylindrical design as well.) As shown in Fig 1c, vertical force (O) on a cuspal incline would produce a resultant line of force (F) perpendicular to the impact area. The perpendicular distance (D) from the crest of the ridge, multiplied by the resultant force (F) is the torque value, which is concentrated at the crest of the ridge4 rather than distributed along the surfaces of the implant as it is in natural teeth (Fig 1a). This concept is consistent with bone loss found in implants, which is almost always initiated at the crest of the ridge. Reduction of Torque. The cusp inclines can be reduced, which will flatten the impact area, thus producing a more vertical resultant line of force (Fig 1d). The perpendicular distance (d) from the crest of the ridge to the resultant line of force is reduced, thus effectively reducing the torque (lateral force) on the crestal bone. A true cusp-to-fossa relationship should be created in centric occlusion, with no contact in working- or balancing-side relationships where possible.
Alteration of Anterior Impact Area

The maxillary single tooth restoration is vulnerable to loosening of the retaining screw (regardless of design, precise interface fit is essential). As shown in Fig 2a, the occlusal impact area usually produces an inclined resultant line of force (F) because
of the vertical overlap of the incisors. High levels of torque are produced on the retaining screw (FxD). Optimal implant orientation, as well as a therapeutic alteration in occlusal impact area (discussed later), effectively reduces torque. The resultant line of force can be redirected more vertically by altering the occlusal impact area to provide a horizontal stop (Fig 2b). The resultant line of force is more in line with the implant orientation and its supporting bone, thus effectively reducing torque on the retaining screw and alveolar bone. In general, the location and impact area (inclination) should be given serious consideration in the restorative phase of implant-supported prostheses. The favorable force distribution associated with splinted natural teeth6,7 (resulting from the micromobility of natural teeth) does not apply to multiple-implant-supported prostheses. The micron-mobility of osseointegration (less than 100 m) tends to concentrate force distribution in the area of force application.
Location of the Impact Area

Buccolingual Location of the Impact Area. The buccolingual location of the impact area (O, Fig 3a) is under the control of the clinician. In the posterior maxillary areas, the implant is most often placed lingually and slightly inclined because of bone topography. When a normal buccolingual occlusion is used, even with diminished cuspal inclination as discussed previously, the resultant line of force (F) falls at some distance (D) from the crestal bone. This produces unwanted torque. When the teeth are arranged in crossbite relationship, occlusal force exerted on the same cuspal inclination produces a resultant line of force that falls much closer to the crestal bone (d ), thus reducing torque (Fig 3b). Vertical Level of the Residual Ridge Crest. The vertical distance from the occlusal end of the implant to the occlusal impact area (O, Fig 4a) is significant because it represents a lever arm with the fulcrum at the crest of the alveolar ridge. Posterior maxillary implants are usually inclined palatally because of the dictates of bone anatomy. Occlusal force applied to a relatively flat cuspal inclination produces a resultant line of force that is inclined in relation to the orientation of the fixture. Even with relatively flat cusp inclines and minimal palatal inclination of the implant, as the vertical level of the crest of the residual ridge moves superiorly, the distance of the resultant line of force to the crest of the ridge increases (x, y, z, Fig 4a). This increases the lateral torque on the crestal bone. On most implants, the resultant line of force from occlusal contact is rarely in the long axis of the implant itself. As in Fig 4a, the greater the distance from occlusal contact to the crest of the bone, the larger the lateral torque exerted on the crestal bone. As the palatal inclination of the implant increases, and/or the resultant line of force becomes more inclined, the more exaggerated are the increases in torque as the crest of the residual bone is located more apically (X, Y, Z, Fig 4b). To summarize, micromovement of the periodontal ligament allows the
distribution of force along the surfaces of natural tooth roots around the center of rotation in the apical third. An osseointegrated implant has no equivalent micromovement; therefore, the forces are concentrated at the crest of the ridge. Torque can be reduced on the implant by creating true cusp-to-fossa occlusal relationships and/or decreasing the inclination of the occlusal impact area. Alteration of the occlusal relationship (such as a cross bite) provides contact more in line with the implant rather than lateral to it. Lateral eccentric contact on a posterior implant-supported prosthesis should be eliminated when possible. The vertical level of implant location is dictated by anatomy. The greater the implant-occlusal distance, the more torque is produced on the crestal bone.
Force Distribution With Splinted Natural Teeth

A detailed analysis of force distribution with splinted natural teeth has been presented previously.6,7 Therefore, only comparisons will be made as they relate to similar configurations involving multiple-implant-supported prostheses. Lateral Force Production. The chewing stroke has a lateral components that is exerted on teeth through the food bolus, whether the teeth actually contact or not. When the bolus can no longer escape by deformation, it exerts similar lateral force to the teeth as if the teeth were together. However, during bruxism, a slight canine rise will eliminate lateral torque on posterior implants and is advisable. The exception would be when poor alveolar bone supports a natural canine, or when a canine location is an implant site. Splinted Natural Teeth. Occlusal force on the buccal slope and lingual cusp incline of a mandibular tooth produces a resultant line of force inclined lingually ( Fig 5a). (In the maxillary arch the resultant line of force is inclined buccally.6,7 ) In a straight arch, multiple-tooth splint, if an occlusal force is applied only on the first premolar (hard bolus), the lingually inclined resultant line of force would initiate micromovement about the vertical center of rotation located in the middle abutment ( Fig 5b). The periodontal fibers would distribute compression, tension, and rotational forces on all the roots (arrows , Fig 5b). However, as shown in Fig 5c, if a hard bolus applies force only on the middle abutment (O), all of the teeth would tend to rotate lingually (arrows) about the horizontal center of rotation, passing through the apical third of all teeth. The force would be distributed more simply, as a compression or tension on the periodontal ligament, depending on the location in relation to the center of rotation.
Force Distribution on Multiple-Implant-Supported Prostheses

The force distribution with multiple-implant-supported prostheses is completely different than with natural teeth. Occlusal force on the first premolar as previously shown in Fig 5b produces a similar lingually inclined resultant line of force. However, the crestal bone on that tooth absorbs the brunt of the force (arrow, Fig 5d ). The internal force on the retaining screws and its effect on force distribution will
be discussed later. When occlusal impact force is exerted on the middle tooth of the implant-supported prosthesis, similar to a natural tooth splint shown in Fig 5c, the lingually inclined resultant line of force distributes most of the force to the crest of alveolar bone of the middle implant (arrow, Fig 5e) with little distributed to the adjacent implant sites. Micromovement and Force Distribution. The same principle is applied to multiple-implant-supported prostheses that is applied to a single implant; namely, in the absence of micromovement provided by the periodontal ligament, there is no effective force distribution to multiple implants in the same prosthesis. This is because the prosthesis is stiff (rigid) and the implants and bone have only micron-movement, which is not great enough to effectively distribute force to all of the implants. However, multiple-fixture force transmission can take place because of the deformation of retaining screws1,2 and possible overload caused by poor interface fit between prosthesis and abutments.1 Retaining Screw Deformation and Stress Distribution. Because of their reduced size and metallurgical composition, the abutment and prosthesis retaining screws permit more deflection (flexibility) than other members of the total prosthesis-fixture-investing bone system. Whatever force transmission takes place between multiple implants finds its origin in the deformation (flexibility) of the retaining screws.1,2 However, this is extremely difficult to quantify on multiple abutments.3 Rangert et al2 found that retaining screw deformation permitted 100-m (0.1-mm) vertical depression of a natural tooth that was splinted to a fixture on an experimental model. It is debatable whether 100 m of vertical movement is enough to distribute clinically significant force to the periodontal ligament. Certainly 100 m of lateral movement is not enough to distribute force to the periodontal ligament, because "normal" tooth movement is in the range of 0.5 mm (previously defined in this text as micromovement, which distributes stress). Modulus of Elasticity of the Gold Retaining Screws. Gold retaining screws are not rigid. This can be demonstrated by screwing a rigid multiple-implant metal ceramic-casting into place with different patterns of gold screw tightening. Changes occur in the abutment/gold coping interface not because the rigid metal ceramic material flexes, but because the gold screws can elongate. Gold screws are, therefore, the most "flexible" portion of the system and permit enough micromovement to distribute force (to the fixtures). However, as demonstrated by the Rangert et al2 experiment, the magnitude of the deflection of the retaining screws (abutment and gold screws) is in the extreme lower end of the range of micromovement, defined here as 0.1 to 0.5 mm. Pending three-dimensional finite element analysis of multiple-fixture-supported prostheses, it is unknown at what micron deflection range force transmission will be effectively transmitted to all fixtures.
Resultant Force Distribution. If an occlusal force is applied to the buccal slope of the middle tooth of a multiple-implant-supported prosthesis (Fig 6a), a lingual resultant line of force will be generated. The degree of force distribution to the adjacent implants depends on the relative of elasticity of the gold screws and the interface fit of all the components of the system. Over a period of time, more force will be distributed to adjacent implants (arrows) because of the micromovement of the gold screws. To prevent undetected gold screw fracture caused by metal fatigue, with possible overload of the remaining implants, it is advisable to replace the gold screws during the lifetime of the restoration. Cantilevered prostheses or angulated abutments place greater stress on gold screws and the more rigid titanium abutment screws. Sheer Stress. As shown in Fig 6b, an occlusal force that results in a buccal or lingual line of force creates shear force on the gold retaining screw, titanium abutment screw, and the superior portion of the implant itself (arrows). To prevent loosening and/or breakage, a number of factors are significant: (1) inclination of the impact area (cusp inclines); (2) vertical distance from the occlusal impact to the implant and to the abutment; (3) location of the impact area lateral to the axis of the implant; and (4) the inclination of the implant relative to the line of force generated by the impact area (occlusion).
Mechanism of Interface Force Distribution

The gold retaining screw must be tightened sufficiently (10 Ncm) to preload the interface between the prosthesis (gold cylinder) and the abutment2,3 (Fig 7a). As long as the force application does not exceed the abutment-prosthesis interface preload value, the interface bears the load (arrows). Thus, the preloading of the abutment-prosthesis interface effectively limits shearing force on the retaining screw. If the preload value is exceeded, the interface will begin to open as the gold screw deforms and bears an increasing load until fracture. In this case the load is then shifted to the remaining fixtures with the possibility of overload. Gold Screw Tightening. If the gold screw is insufficiently tightened, less occlusal force is required to separate the interface, and this can directly load the gold screw. The gold screw can be distorted or break because of insufficient preloading and/or poor interface fit. Excessive tightening can strip the threads and deform the gold screw.
The Effect of Poor Abutment-Prosthesis Interface Fit

Poor abutment-prosthesis interface fit can place more shear stress on the gold retaining screw than it was designed to withstand. As shown in Fig 7b, when the interface fit is defective, the resultant line of occlusal force is not optimally resisted by the abutment-prosthesis interface. Although some force is distributed to the abutment at the point of contact, excessive shearing force is exerted directly on the gold screw.
Multiple-Implant-Supported Prosthesis. As stated previously, poor interface fit leads to a high incidence of gold screw metal fatigue and eventual failure. In single tooth restorations, loosening, and gold screw failure become clinically obvious. However, in multiple-implant-supported prostheses, poor interface fit and subsequent gold retaining screw failure shifts the occlusal load to those sites where there is good preloaded interface fit. As a result, the remaining implants can be subject to occlusal overload. This is particularly critical if the gold screw failure takes place on a distal abutment. A lever arm that puts greater load on the adjacent fixture-abutment-prosthesis configuration is created. Titanium Abutment Screw. Titanium abutment screws are stronger than gold (cylinder) retaining screws. Therefore, metal fatigue will usually produce gold screw failure before the titanium abutment screw is affected. Single Tooth Abutment. Poor interface fit usually causes loosening or fracture of the retaining screw and continual failure. When a UCLA abutment-type restoration is required, premanufactured cylinders should be used rather than plastic waxing sleeves, which are technique sensitive fit. Several factors can reduce the shear stress on the retaining screws: (1) reduction of the inclination of the impact area (Fig 1d); (2) narrowing of the occlusal table, and/or moving the occlusal contact area more in line with the implant location (crossbite, Fig 3b); (3) improved implant orientation with the use of computerized tomography9 and surgical guides10; and (4) alteration of the impact area for anterior maxillary single tooth restorations (Fig 2b).
Vertical Component Force

Vertical component force (O) on the distal implant of a cantilevered prosthesis results in most of the force distributed to that implant (Fig 8a). If the implant is cylindrical, the force is concentrated at the apex; if it has a screwlike configuration, the force is concentrated at the outside edges of the screw threads.4 Vertical component force on the cantilever, however, will tend to have apically directed force on the distal implant (distributed as above) and occlusally directed force on the prosthesis anterior to it (Fig 8b). This force distribution is created by the micromovement between the prosthesis, abutments, and implants resulting from retaining screw elongation rather than implant movement in bone.
Significance of Differential Mobility in Splinted Natural Teeth

When mobile natural teeth are splinted to firm teeth, the force transmission pattern depends on the degree of differential mobility between the teeth, their strategic location, and the direction and point of the application of force. If the macromobile teeth (Class II, macromobility) are surrounded by firm teeth (Class I, micromobility), the weak mobile teeth are protectively splinted (Fig 9a). The greater the differential in mobility between the strong and weak teeth, the more the force is distributed to the firm teeth and relatively little to the more mobile teeth.
For example, lateral force applied to the firm posterior abutment (arrow, Fig 9a) initiates a rotation about the center of rotation located approximately in the firm canine on that side. However, the lateral force is distributed to the remaining firm teeth only, with very little to the more mobile premolar teeth included within the splint because of their high differential mobility (Fig 9a). Mobile Terminal Abutment. Mobile terminal abutments create special diagnostic and clinical problems because of the high differential mobility between the abutments and their strategic location. As shown in Fig 9b, when the terminal abutments of splinted teeth have a high differential mobility, lateral force (arrow) initiates a rotation about the firm canine on that side, as shown in Fig 9a. However, the mobile terminal abutment creates a lever arm mechanical advantage that can cause a metallurgical failure of the prosthesis, loosening of the castings on the anterior teeth, and /or periodontal breakdown of the firm anterior teeth. In summary, force transmission depends on micromovement. Differential mobility between natural tooth abutments distributes forces disproportionately to the firm teeth. Mobile posterior abutments within a multitooth splint can cause lever arm overload forces on the strong anterior abutments.
Combined Prosthesis Using Implants and Natural Teeth

Clinical Considerations. Most clinicians agree that whenever possible, implant-supported prostheses should be free standing. Assemblage procedures are simplified and the vast difference in differential mobility complicates diagnosis. However, in combined prosthesis design, natural tooth intrusion tends to separate internal attachments and/or telescopic copings vertically. Posterior working side forces (Fig 1a) and anterior incisal guidance (Fig 2a) tend to produce buccally inclined resultant forces in the maxillary arch,6,7 which can produce horizontal separation of the prostheses. Splinted natural maxillary teeth can move buccally away from adjacent free-standing implant-supported prostheses. Decreased incisal guidance and posterior cusp inclines, and an optimal buccolingual occlusal arrangement (Figs 1b, 1d, 2b, 3b) can effectively reduce this hazard. In the mandible, the resultant lines of force are usually lingually directed (Fig 5a )6,7 and have less tendency to separate the component prostheses horizontally. However, combined implant- and tooth-supported prostheses may be clinically required, which necessitates diagnostic evaluation because of the vast difference in differential mobility. Methods must also be used to prevent separation. When combining a fixed retrievable implant-supported prosthesis with natural teeth, internal attachments or telescopic copings can be used. Internal Attachments. Because the implant-supported prosthesis is fixed and retrievable, the female portion of the attachment is located in the natural tooth crown (Fig 10a). However, the natural teeth can be intruded vertically into the sockets, leaving the male portion of the attached extruded occlusally. To prevent this, a
U-shaped pin can be added to the internal attachment. U-Shaped Pin Attachment. A U-shaped pin (Selle R, CDT, So-Mar Dental Studies, Jamaica, NY; personal communication, 19XX) can be placed through the interface between the male and female internal attachment (from the lingual aspect). Special laboratory procedures are required for semiprecision or precision attachments. Because the male and female relationship is so precise, it is suggested that the U-shaped pin be in place during cementation. Telescopic Copings. An alternative technique for combining natural tooth and implant-supported prostheses uses substructure copings that are permanently cemented to the natural teeth (Fig 10b). The superstructure telescopic copings over the natural teeth are attached to the fixed-retrievable implant-supported prosthesis. The telescopic superstructure coping is temporarily cemented to the natural tooth coping; the implant portion of the prosthesis is screw retained (Fig 10b). Some clinical problems can occur: (1) the telescopic copings can separate and the natural tooth can be intruded vertically into the alveolar bone; (2) "temporary" cement between the telescopic copings can harden and prevent separation; and (3) secondary caries can occur.
Force Transmission in Combined Natural Tooth and Implant-Supported Prostheses

Differential Mobility. The discussion of differential mobility of teeth and its effect on force distribution (Figs 9a and 9b) does not apply to the comparison of natural teeth and implants involved in the same prosthesis. As pointed out previously, micromovement is essential for force distribution. Osseointegration, by definition, permits no movement other than the modulus of elasticity of bone measured in microns. Lever Arm Effect. Internal attachments or telescopic prosthesis fabrication involving many splinted natural teeth do not support implants. It is the reverse: the implants support the natural teeth. Figure 11a illustrates two posterior implants with a long pontic attached. The splinted anterior teeth provide an internal attachment erroneously intended to support the posterior implant-retained prosthesis. Mutual support would take place only if natural teeth were in the place of the implants. In that case, micromovement of all the teeth would facilitate mutual support and force distribution. The most rigid framework provides the best force transmission.5-7 However, because implants provide no micromovement (only micron-movement below 100 m), the normal movement of the anterior splint exerts enormous force through the long lever arm of the pontic (Fig 11a). The configuration of the prosthesis should be redesigned to reduce the stress on the osseointegrated interfaces.
New Design Principles for Combined Prostheses
Reduced Implant Lever Arm. The following principles should be applied: l. A cantilevered pontic extended from a free-standing implant-supported prosthesis should never exceed that which can be supported by the implants alone.
2. Attachment of splinted natural teeth to an implant-supported cantilever increases the load on the implants rather than supporting them. 3. Implants support the teeth and not visa versa. 4. When combining splinted natural teeth with an implant-supported prosthesis, the lever arm on the implant-supported portion should be reduced as much as possible (ie, shorter than if it were a free-standing prosthesis). 5. A cantilevered pontic should be extended from the splinted natural teeth, as far as appropriate, as if it were free standing. 6. The method of attachment between the two prostheses should be relatively nonrigid (ie, semiprecision with or without a U-shaped pin). 7. Rigid attachments (eg, precision attachments, cantilevered screw attachments) cause possible lever arm overload on the implants. Combined Prosthesis Design. The erroneous design in Fig 11a should be modified by applying the above principles. Cantilevered pontics are extended from each segment that can be supported by the respective natural teeth and implants (Fig 11b). The internal attachment between the two should not be overly rigid and is designed to prevent horizontal separation rather than force distribution. This design reduces the stress on the implants without overloading the natural teeth.
Summary
Force distribution between members of a system depends on a complex relationship between the relative stiffness of the structural parts with its investment medium (periodontal ligament or osseointegration). A rigid prosthesis is necessary to distribute force in all types of multiple-unit-supported prostheses. When force is applied to one portion of a multiple-tooth-supported prosthesis, the micromovement of the periodontal ligament (0.5 mm range) initiates movement of the whole rigid structural entity (teeth and prosthesis). This micromovement distributes force to the remaining natural teeth. With a multiple-implant-supported prosthesis, force application to one portion is distributed to the nearest osseointegrated fixture interface. The force is concentrated at that interface. The amount of distribution to the remaining fixtures depends on the degree of deformation (flexibility) of the investing bone, fixture, abutment, retaining screws, and prosthesis. The range of deformation of the most flexible part of the system (the retaining screws) is at the lower end of micromotion (in the range of 100
m). Therefore, the amount of force distribution to the remaining fixtures is much less than that found with a periodontal ligament, which can permit 0.5 mm of movement (500 m). Paradoxically, because of the relative "flexibility" of the periodontal ligament, force distribution is dependent on a rigid structural entity of teeth and prosthesis. Conversely, because the osseointegrated interface permits no movement, force distribution depends on some deformation of the fixture-abutment-retaining screw complex. Combined prostheses using implants and natural teeth should be approached with caution. Internal attachments and/or telescopic coping construction have been used. However, force transmission is completely different in both segments. Implants always support the natural teeth, rather than visa versa, because of the overwhelming differential in mobility between periodontal ligament micromovement and the osseointegrated implant interface. New design principles have been recommended to avoid implant overload.
1. Skalak R. Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent 1983;49:843-848. 2. Rangert B, Gunne J, Sullivan DY. Mechanical aspects of a Brnemark implant connected to a natural tooth: an in vitro study. Int J Oral Maxillofac Implants 1991;6:177-186. 3. Brunski J. Biomaterials and biomechanics in dental implant design. Int J Oral Maxillofac Implants 1988;3:85-97. 4. Rieger MR, Mayberry MS, Brose MO. Finite element analysis of six endosseous implants. J Prosthet Dent 1990;63:671-676. 5. Weinberg LA. Lateral force in relation to denture base and clasp design J Prosthet Dent 1956;6:785-800. 6. Weinberg LA. Force distribution in splinted anterior teeth. Oral Surg Oral Med Oral Pathol 1957;10:484-494. 7. Weinberg LA. Force distribution in splinted posterior teeth. Oral Surg Oral Med Oral Pathol 1957;10:1268-1276. 8. Posselt U. Studies in the mobility of the human mandible. Acta Odontol Scand 1952;10(suppl 10):3. 9. Weinberg LA. CT scan as a radiologic data base for optimum implant orientation. J Prosthet Dent 1993 (in press). 10. Mecall RA, Rosenfeld AL. The influence of residual ridge resorption patterns on implant fixture placement and tooth position. Part II. Presurgical determination of prosthesis type and design. Int J Periodont Rest Dent 1992;12:32-51.
Figs. 1a to 1d : Comparison of torque production in natural and implant-supported prostheses relative to changes in cuspal inclination. O = vertical occlusal force; F = resultant force; CR = center of rotation; D, d = distance; T = torque.
Figs. 2a and 2b : Modification of the anterior impact area can reduce torque. F = resultant force; D = distance; T = torque.
Figs. 3a and 3b : Location of the impact area more in line with the implant can reduce torque (posterior cross bite, right). O = vertical occlusal force; F = resultant force; D = distance; T = torque.
Figs. 4a and 4b : Vertical level of the implant can influence torque production (left). When the implant is severely inclined (right), the increased vertical level of the residual bone can exaggerate torque production. O = occlusal impact area; F = resultant line of force; x, y, z = increasing distance of line of force to crest of ridge; X, Y, Z = torque increases as the crest of the ridge is located more apically.
Figs. 5a to 5e : Comparison of force distribution with a natural tooth splint compared to an implant-supported prosthesis. F = resultant line of force; CR = center of rotation; O = occlusal force.
Figs. 6a and 6b : Gold screw micromovement permits force distribution (left). Lateral force produces structural shear Stress on all the components (right). O = occlusal force; F = resultant line of force.
Figs. 7a and 7b : Interface fit affects shear stress on gold retaining screws. F = force application.
Figs. 8a and 8b : The location of vertical force changes the force distribution to the implants. O = vertical component force.
Figs. 9a and 9b : When the terminal abutment of a prosthesis is firm, the weak included teeth are mutually supported (left). A mobile terminal abutment produces a lever arm that can overcome strong anterior teeth (right). R = center of rotation; II = Class II, macromobility; I = Class I, micromobility.
Figs. 10a and 10b : An internal attachment with a U-shaped pin can prevent vertical separation ( left). A telescopic coping can be used to combine natural teeth with a fixed-retrievable implant-supported prosthesis (right).
Figs. 11a and 11b : A long lever arm is produced when an implant-supported prosthesis is cantilevered to a natural tooth prosthesis (left). Less torque is created if cantilevers are extended from both prostheses and joined with an internal attachment (right).

The Biomechanics of Force Distribution in Implant-Supported Prostheses

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JOMI on CD-ROM, 1993 Jan (19-31 ): The Biomechanics of Force Distribution in Implan

Copyrights 1997 Quinte