Original Contributions

Clinical Dentistry
Utility of measuring anterior-posterior spread
to determine distal cantilever length off a
fixed implant-supported full-arch prosthesis
A review of the literature
Leora Walter, DDS; Gary Greenstein, DDS, MS

ABSTRACT

Background. Historically, anterior-posterior (AP) spread assessments were often used to determine
the length that a distal cantilever could be extended off an implant-supported fixed full-arch
prosthesis.
Types of Studies Reviewed. The authors searched the literature for articles that used AP spread
to calculate cantilever size to be constructed off implants bearing a fixed implant-supported full-arch
rehabilitation.
Results. The data indicate that the relationship between AP spread and cantilever length is not
linear and many influences (such as beam theory, cantilever size differences in the mandible versus
maxilla, number and distribution of placed implants, prosthetic materials, and framework design)
need to be considered when computing cantilever length with respect to fixed implant-supported
prostheses.
Practical Implications. Recommendations using AP spread assessments to compute cantilever
lengths have not been validated by means of prospective scientific evaluations. Therefore, AP
spread evaluation is just one of many issues that need to be considered when determining distal
cantilever length associated with a fixed full-arch implant-bearing prosthesis.
Key Words. Anterior-posterior spread; AP spread; cantilever; dental implants; prostheses.
JADA 2020:151(10):790-795
https://doi.org/10.1016/j.adaj.2020.06.016

A
nterior-posterior (AP) spread measurements are often used to determine distal cantilever
length that extends from an implant-supported fixed full-arch restoration.1-4 The concept of
using AP spread to calculate cantilever size was first proposed by English1 in 1990. He stated
that biomechanical principles need to be applied to ensure a successful restorative outcome when a
cantilever is supported by means of a full-arch fixed implant-bearing prosthesis. AP spread was defined as
the distance between a line connecting the distal of the most distal implants of a full-arch implant-
supported prosthesis and a line through the center of the most anterior implant (Figure). English1
suggested that a cantilever’s span could be 1.5 times the AP spread in the mandible. This was his
opinion, and it did not evolve from a vigorous scientific assessment. Other clinicians also failed to
provide systematic prospective evaluations to validate that AP spread measurements could be used to
compute distal cantilever lengths.2-5 Questions arise as to what evidence there is that AP spread can be
used to determine cantilever size and what other factors need to be considered to calculate cantilever
length off implants that uphold a full-arch implant-supported prostheses. This is an important issue
because failure to adequately plan cantilever length and provide sufficient support for this type of
construct can result in stress on a prosthesis, which can cause screw loosening, screw breakage, prosthesis
fracture, implant fracture, and implant de-osseointegration.5-10 Therefore, it was deemed important to
Copyright ª 2020
critically appraise the relationship between AP spread and other factors (such as differences in cantilever
American Dental
Association. All rights size in the mandible versus maxilla, number and distribution of placed implants, prosthetic materials, and
reserved. framework design) that affect the cantilever length off an implant-supported fixed full-arch prostheses.

790 JADA 151(10) n http://jada.ada.org n October 2020

Figure. Anterior-posterior (AP) spread, as defined by English.1 The posterior line connects the distal-most portion of the
distal implants. The anterior line is placed in the center of the anterior-most implant and parallel to the posterior line. AP
spread is the distance between these 2 lines (blue arrow).

METHODS
Articles included in this critical analysis of the literature related to AP spread and biomechanics of
cantilevers were found by means of searching PubMed, Ovid, Embase, Dentistry and Oral Sciences
Source, and Cochrane using the following terms “AP spread,” “anteroposterior spread” with “fixed
prosthesis,” “cantilevers,” and “biomechanics of cantilevers.” Relevant articles were hand searched
to determine whether additional articles could be included in this analysis. All 11 human clinical
trials found in the literature related to AP spread were included in this literature analysis and
critiqued. Therefore, no exclusion criteria were used to negate the usefulness of studies; rather, each
study was addressed and critiqued directly.

DISCUSSION
AP spread to determine distal cantilever length
Numerous authors have suggested the following amounts of AP spread that could be used to
determine distal cantilever size off an implant-supported fixed full-arch prosthesis: less than 1,9 1.5,1
2,3 and 2.5.4 Misch and Misch-Dietsh4 suggested that a 2.5 AP spread was possible when force
influences (for example, parafunction or crown to root ratio) are low and the prosthesis is well
supported (that is, adequate number of implants). Others advised cantilever length could be a span
of 2 through 3 premolars,11 less than 15 mm,5,12 15 through 20 mm,2,13 and 20 mm.6 However,
these recommendations concerning cantilever length are grounded in clinical experience and
retrospective assessments with respect to decreased numbers of prosthetic complications and not
prospective scientific evaluations to determine a precise relationship between AP spread and
cantilever length.
Class 1 lever system related to AP spread
There are biomechanical concepts that relate AP spread and cantilever length to lever systems. A
dental cantilever is a type 1 lever; the pivot (fulcrum) is between the applied biting force and the
occlusal load on a prosthesis.2 The occlusal load is computed by means of multiplying the biting
force times cantilever length. The fulcrum is the connector at the terminal abutment. The canti-
lever arm (effort arm) generates torque on the prosthesis and bending moments can form in 3
clinical axes (occlusoapical, mesiodistal, faciolingual).7,14,15
Researchers from several studies indicated that bending moments induced by means of load-
bearing cantilevers can increase forces 2 through 3 times on the supporting implants compared
with stresses normally detected on a single implant.7,14,15 As the length of the effort arm increases,
tensile, compressive, and shear forces increase stress on the prosthesis. To counteract these vectors, a
large resistance arm is needed (distance from the fulcrum to most anterior implant).2 To clinically ABBREVIATION KEY
accomplish this, anterior implants of a fixed full-arch restoration should be placed as anteriorly as AP: Anterior-posterior.

JADA 151(10) n http://jada.ada.org n October 2020 791

 possible, thereby creating a large AP spread. Ideally, to reduce stress on a cantilevered prosthesis, a
short effort arm (cantilever) and a long AP spread (resistance arm) are desired.2
Cantilever lengths associated with full-arch reconstructions: maxilla versus mandible
Researchers have differentiated between cantilever lengths in the maxilla versus the mandible. For
example, English1 suggested that a cantilever length of 1.5 times AP spread should be used in the
mandible, but it should be shorter in the maxilla owing to diminished bone loading capacity in the
maxilla. Rasmussen16 indicated that a 20-mm cantilever in the mandible is appropriate, and a 15-
mm length was proper in the maxilla. Naert and colleagues17 agreed that a maximum of 20-mm
cantilever in the mandible was reasonable, but only 10 mm should be used in the maxilla. Ran-
gert and colleagues2 were more cautious and recommended a 15- through 20-mm cantilever in the
mandible and 10-mm in the maxilla. These authors disagree on cantilever length in the maxillary
and mandibular arches, however, they concur that mandibular cantilevers can be longer than in the
maxilla due to increased strength of mandibular cortical bone. It has been recorded that the
mandibular bone is 1.8 times denser than maxillary bone.18 However, none of these articles sys-
tematically assessed the utility of using AP spread to reliably predict what cantilever length would
result in successful prostheses in the mandible and the maxilla. Furthermore, confounding variables,
such as jaw and tooth size, occlusal forces, and different materials used, preclude defining a precise
AP calculation that would apply to all patients.

Number of implants supporting a cantilevered prosthesis

When English1 described the relationship between cantilever length and AP spread for a
mandibular reconstruction, the prosthesis included 5 implants placed intraforaminally. The center
implant was inserted as anteriorly as possible, thereby creating a large AP spread (1.5). In contrast,
other clinicians believed that the number of implants is the critical determinant with respect to
computing cantilever length and not the AP spread of implants.2,7,13 In this regard, Taylor and
Bergman13 stated that when 4 implants are inserted, a mandibular cantilever should not exceed
15 mm, and if 5 or 6 implants are used, then the cantilever can extend 20 mm. However, these were
empirical suggestions. Additional evidence underscored that the number of implants was more
important than AP spread for determining cantilever length was provided by McAlarney and
Stavropoulos.7 They simulated clinical conditions and applied load at various points along the
prosthesis and mathematically concluded that there is no linear relationship between AP spread and
cantilever length and that cantilever length was dependent on the number and distribution of
implants between the most anterior and posterior implants.

Spacing of implants, cross-arch stabilization, and arch form

Using mathematical equations, Skalak19 found that correct distribution of implants reduces the load
per implant and facilitates constructing a larger cantilever. Others agreed that appropriate spreading
of implants accommodates stress placed on cantilevers.14,20 Successful use of the “All-on-4” concept
has shown that bilateral cantilevers can be supported with a limited number of well-distributed
implants.21
In addition to positioning implants, turning the corner of the arch with a prosthesis is important
with respect to countering dislodging and lateral forces associated with a cantilever, and it enhances
prosthesis stability.19,22 This is referred to as cross-arch stabilization. Grossman and colleagues23
stated “a rigid cross-arch fixed prosthesis will distribute loads to several implants more effectively
than a similar prosthesis without cross-arch stabilization.” In our opinion, this concept appears to be
reasonable; however, there are no research data that assessed whether cross-arch stabilization fa-
cilitates creating a larger cantilever.
Edentulous arches are ovoid, tapered, or square. Ovoid arches are the most common,
followed by square and then tapered.24 A tapered or ovoid arch form allows for a more favorable AP
spread of implants than a square arch.4 A square arch results in implants being placed in a straight line,
and it therefore has a shorter AP spread.25 Owing to its effect on AP spread, arch form is a factor that
should to be considered when planning the size of a distal cantilever off a full-arch prosthesis.

Bone loss due to cantilevered prostheses

The effect a cantilever has on bone resorption is debatable. Lindquist and colleagues26 reported
that anterior implants had more bone loss than posterior implants after 1 year when they

792 JADA 151(10) n http://jada.ada.org n October 2020

supported a cantilever as part of a mandibular implant-supported fixed full-arch prosthesis.
However, after 3 years, there was no difference between osseous resorption on anterior and
posterior implants. At 2 years, Ahlqvist and colleagues27 noted more bone loss in anterior than
posterior implants when supporting a cantilever in the mandible, but not in the maxilla of a
fixed full-arch restoration. In contrast, Naert and colleagues17 found no difference in the
amount of bone resorption among anterior and posterior implants associated with a canti-
levered prosthesis. Similarly, when the All-on-4 concept with bilateral cantilevers for full-arch
rehabilitation was used, no additional bone loss was noted compared with conventional
therapy.21,28 With respect to unilateral cantilevers, researchers from 2 5-year studies found no
additional bone loss when a short cantilever was present.29,30 These conflicting data preclude
making a determination as to whether there is a relationship between cantilever length and
bone loss adjacent to implants supporting a fixed full-arch restoration. Furthermore, no data
were found relating AP spread to bone loss.

Cantilever design related to beam theory

The flexibility of a cantilever can be computed using beam theory.31 A beam’s displacement
(movement) is dependent on the rigidity of the beam, which is a function of its length.31 Increasing
the length of a beam increases its flexibility and shortening the beam makes it more rigid. It can be
computed that if beam length is doubled or its thickness is cut in one-half, then the flexibility of the
beam (cantilever) is 8 times greater.8,32,33 These facts dictate that a cantilever should be limited in
size or be as small as possible because a beam will flex, resulting in increased stress on a prosthesis,
which can cause cantilever deformity and possible fracture of the luting media, porcelain, or
retaining screws.
To accommodate the flexibility of a cantilever, Worthington and colleagues34 and Sones35
recommended adequately bulking the material distal to the posterior abutment, as well as around
each cylinder. Contrastingly, Staab and Stewart36 reported that it was not the bulk of material but
the height of the connector that played a role in the success of a cantilever. Taylor and Bergman13
agreed that it was the height not the thickness of the connector that was important. To determine
the rigidity of a cantilever for occlusal loading, the following formula can be used: rigidity ¼
WH3/12.37 This relationship indicates that doubling the width (W) of the connector doubles its
strength, but doubling the height (H) increases its strength 8 times.37
There are situations in which the height of the framework is limited owing to anatomic con-
siderations. Accordingly, its cross-sectional design becomes important and needs to be adjusted to
allow for minimum height, while providing maximum resistance to flexion. Staab and Stewart36
studied the following 4 framework cross-sectional designs: L-, I-, and U-shaped and elliptical.
They reported that the I-beam was the most effective cross-sectional design to withstand occlusal
forces when there is minimum restorative height available. Others reached the same conclusion that
an I-beam design provides the most strength and rigidity and minimizes bulk and weight of a
framework.16,38,39
The above discussion indicates that there are numerous biomechanical factors that need to be
considered when determining cantilever length that could be extended off of a fixed full-arch
restoration. Cantilever length established solely on AP spread does not mathematically take into
account beam theory. Furthermore, calculations based on AP spread provide a wide-ranging general
estimate of possible cantilever lengths that can under- or overestimate the span of a cantilever that
could successfully be supported with an implant-supported fixed full-arch prosthesis.

Impact of materials used to construct prostheses

Vectors beyond biomaterial tolerances can cause technical problems (for example, screw loosening,
cantilever fracture, and damaged cemented bonds). In this regard, Drago9,40 conducted 2 studies
addressing materials used to construct cantilevers associated with implant-supported full-arch fixed
prostheses. Drago evaluated an interim prosthesis made from acrylic and a final prosthesis fabricated
from titanium. The prosthetic complication rate was greater with the interim acrylic prosthesis than
with the definitive metal prosthesis irrespective of AP spread.9,40 From another perspective,
Skalak19 stated that the distribution of load caused by means of a cantilever depends on the relative
stiffness of the material used to fabricate the restorative framework. The more rigid the prosthesis,
the more evenly distributed the forces, and therefore the cantilever is more resistant to deformation

JADA 151(10) n http://jada.ada.org n October 2020 793

 and can be longer.16,41 Staab and Stewart36 agreed that survivability of a cantilevered prosthesis is
directly dependent on the fatigue life of the metal alloy framework. If a force exceeds two-thirds the
stress limit of a material (for example, metal), it fatigues and eventually fractures.31 Therefore, long
cantilevers should be avoided to reduce prosthetic complications. Additional evidence that the
material selected for a framework affects prosthesis survivability was provided by Zarb and Schmitt.6
After experiencing framework fractures, the constructs were remade, changing the silver palladium
alloy to one with higher yield and greater tensile strength. Subsequently, no additional framework
fractures occurred. They concluded that AP spread was not the determining factor for success of a
cantilevered prosthesis; rather, it was the rigidity of the framework material that was critically
important.

Other applications of AP spread assessments in the literature

This analysis discussed AP spread in relationship to the distal cantilever length off a fixed implant-
supported fixed full-arch prosthesis, it is apparent that many considerations for a fixed prosthesis can
apply to a removable prosthesis or unilateral cantilevered fixed implant prostheses. In this regard,
Kosinski42 suggested that cantilever length for removable implant retained overdentures can be
created distal to implants bilaterally by means of assessing the AP spread and multiplying it by 1.5.
Others mentioned the cantilever length could be 2.5 times the AP spread or 15 mm for over-
dentures.43 However, these numbers are based on literature addressing cantilever length associated
with fixed prostheses. These authors provided no scientific data using AP spread to determine
cantilever length for implant-bearing removable prostheses.
Pertaining to unilateral cantilevers off an implant-supported fixed prosthesis, Greenstein and
Cavallaro44 used the term AP spread when discussing a single cantilever off 2 implants. They
reviewed numerous clinical trials and surmised that unilateral cantilevers were predictable
prosthetic constructs. The data in the article supported the concept that unilateral fixed pros-
theses could be constructed with a short cantilever (z8 mm) with an interimplant distance of
approximately 8 mm (AP spread). These findings were related to Brunski’s45 calculations with
respect to managing compressive forces on the terminal abutment and tensile vectors on the
anterior abutment. However, once again, no specific clinical trials were conducted to relate the
length of the cantilever to AP spread and ultimately to the clinical success of unilateral canti-
levered prostheses.

CONCLUSIONS
Historically, it has been suggested that the length of the cantilever extension associated with a full-
arch implant-supported restoration could be determined using AP spread.1 However, this was an
empirical decision rather than one established on rigorous scientific research. There are no scien-
tifically derived data that permit calculating cantilever length based solely on AP spread. Therefore,
cantilever length should be determined on a case-by-case basis, taking into consideration the
following factors: biomechanics, AP spread, bone quality in the maxilla versus the mandible,
number and distribution of implants, rehabilitation design, and prosthesis material.
With respect to fabricating a cantilever off implants supporting a full-arch fixed prosthesis the
following steps are suggested:
n consider the occlusal load when determining the size, number, thread design, and surface area of
implants to be placed and place enough implants to distribute the occlusal forces;
n maximize implant distribution to reduce the load per implant;
n maximize the AP spread;
n use a cross-arch splint design when working with a full-arch design;
n use rigid material for the framework;
n use an I-beam in cross-section for the framework;
n minimize cantilever length, especially in the maxilla.
The prosthesis should be monitored at regular recall visits to evaluate changes in the integrity of
the framework and the occlusion, especially at the cantilevered segment. Implants and surrounding
bone should be checked to ensure their osseous support has been maintained. Any anomalies to
prosthesis, bone, or implants should be treated accordingly. n

794 JADA 151(10) n http://jada.ada.org n October 2020

Dr. Walter is the course director and a clinical attending, Prosthodontics,
Woodhull Hospital, Brooklyn, NY; and a dentist in private practice,
Prosthodontic and Implant Associates, Mamaroneck, NY. Address
correspondence to Dr. Walter, Prosthodontic and Implant Associates, 745
East Boston Post Rd, Mamaroneck, NY 10543, e-mail leora.walter@gmail.com.
1. English CE. Critical A-P spread. Implant Soc. 1990;
1(1):2-3.
2. Rangert B, Jemt T, Jörneus L. Forces and moments
on Brånemark implants. Int J Oral Maxillofac Implants.
1989;4(3):241-247.
3. Takayama H. Biomechanical considerations in
osseointegrated implants. In: Hobo S, Ichida E, Garcia L,
eds. Osseiointegration and Occlusal Rehabilitation. Tokyo,
Japan: Quintessence Publishing; 1989:265-280.
4. Misch CE, Misch-Dietsh F. Preimplant prosthodon-
tics. In: Misch CE, ed. Dental Implant Prosthetics. St. Louis,
MO: Elsevier Mosby; 2005:168.
5. Chapman RJ. Principles of occlusion for implant
prostheses: guidelines for position, timing, and force of
occlusal contacts. Quintessence Int. 1989;20(7):
473-480.
6. Zarb GA, Schmitt A. The longitudinal clinical
effectiveness of osseointegrated dental implants: the Tor-
onto study, part IIIdproblems and complications
encountered. J Prosthet Dent. 1990;64(2):185-194.
7. McAlarney ME, Stavropoulos DN. Determination of
cantilever length-anterior-posterior spread ratio assuming
failure criteria to be the compromise of the prosthesis
retaining screw-prosthesis joint. Int J Oral Maxillofac Im-
plants. 1996;11(3):331-339.
8. Adell R, Lekholm U, Rockler B, Brånemark PI.
A 15-year study of osseointegrated implants in the treat-
ment of the edentulous jaw. Int J Oral Surg. 1981;10(6):
387-416.
9. Drago C. Ratios of cantilever lengths and anterior-
posterior spreads of definitive hybrid full-arch, screw-
retained prostheses: results of a clinical study. J Prosthodont.
2018;27(5):402-408.
10. McGlumphy EA, Robinson DM, Mendel DA.
Implant superstructures: a comparison of ultimate failure
force. Int J Oral Maxillofac Implants. 1992;7(1):35-39.
11. Brånemark PI, Zarb GA, Albrektsson T. Tissue In-
tegrated Prostheses. Chicago, IL: Quintessence; 1985:51-70,
117-128.
12. Shackleton JR, Carr L, Slabbert JC, Becker PJ. Sur-
vival of fixed implant-supported prostheses related to
cantilever lengths. J Prosthet Dent. 1994;71:23-26.
13. Taylor R, Bergman G. Laboratory Techniques for the
Brånemark System. Chicago, IL: Quintessence; 1990, 34-
26.
14. Brunski JB. Biomechanical factors affecting the
bone-dental implant interface. Clin Mater. 1992;10:
153-201.
15. Osier JF. Biomechanical load analysis of cantilevered
implant systems. J Oral Implantol. 1991;17(1):40-47.
JADA 151(10) n http://jada.ada.org n October 2020
Dr. Greenstein is a clinical professor, Department of Periodontics, College
of Dental Medicine, Columbia University, New York, NY; and a dentist in
private practice, Surgical Implantology and Periodontics, Freehold, NJ.
Disclosure. Drs. Walter and Greenstein did not report any disclosures.
16. Rasmussen EJ. Alternative prosthodontic technique
for tissue-integrated prostheses. J Prosthet Dent. 1987;
57(2):198-204.
17. Naert I, Quirynen M, van Steenberghe D, Darius P.
A study of 589 consecutive implants supporting complete
fixed prostheses, part II: prosthetic aspects. J Prosthet Dent.
1992;68(6):949-956.
18. Kim YJ, Henkin J. Micro-computed tomography
assessment of human alveolar bone: bone density and
three-dimensional micro-architecture. Clin Implant Dent
Relat Res. 2015;17(2):307-313.
19. Skalak R. Biomechanical considerations in osseoin-
tegrated prostheses. J Prosthet Dent. 1983;49(6):843-848.
20. Ogawa T, Dhaliwal S, Naert I, et al. Impact of
implant number, distribution and prosthesis material on
loading on implants supporting fixed prostheses. J Oral
Rehabil. 2010;37(7):525-531.
21. Taruna M, Chittaranjan B, Sudheer N, Tella S,
Abusaad M. Prosthodontic perspective to all-on-4® concept
for dental implants. J Clin Diagn Res. 2014;8(10):ZE16-ZE19.
22. Schweitzer JM, Schweitzer RD, Schweitzer J. Free-
end pontics used on fixed partial dentures. J Prosthet Dent.
1968;20(2):120-138.
23. Grossmann Y, Finger IM, Block MS. Indications for
splinting implant restorations. J Oral Maxillofac Surg. 2005;
63(11):1642-1652.
24. Celebi AA, Keklik H, Tan E, Ucar FI. Comparison
of arch forms between Turkish and North American.
Dental Press J Orthod. 2016;21(2):51-58.
25. Kendrick S, Wong D. Vertical and horizontal di-
mensions of implant dentistry: numbers every dentist
should know. Inside Dent. 2009. July/August:2-5.
26. Lindquist LW, Rockler B, Carlsson GE. Bone
resorption around fixtures in edentulous patients treated
with mandibular fixed tissue-integrated prostheses.
J Prosthet Dent. 1988;59(1):59-63.
27. Ahlqvist J, Borg K, Gunne J, Nilson H, Olsson M,
Astrand P. Osseointegrated implants in edentulous jaws: a
2-year longitudinal study. Int J Oral Maxillofac Implants.
1990;5(2):155-163.
28. Hopp M, de Araújo Nobre M, Maló P. Comparison
of marginal bone loss and implant success between axial
and tilted implants in maxillary all-on-4 treatment
concept rehabilitations after 5 years of follow-up. Clin
Implant Dent Relat Res. 2017;19(5):849-859.
29. Wennström J, Zurdo J, Karlsson S, Ekestubbe A,
Gröndahl K, Lindhe J. Bone level change at implant-
supported fixed partial dentures with and without canti-
lever extension after 5 years in function. J Clin Periodontol.
2004;31(12):1077-1083.
30. Hälg GA, Schmid J, Hämmerle CH. Bone level
changes at implants supporting crowns or fixed partial
dentures with or without cantilevers. Clin Oral Implants
Res. 2008;19(10):983-990.
31. Lundgren D, Laurell L. Biomechanical aspects of
fixed bridgework supported by natural teeth and endo-
sseous implants. Periodontology 2000. 1994;4:23-40.
32. Smyd ES. The mechanics of dental structures.
JADA. 1952;44(2):187-193.
33. Rodriguez AM, Aquilino SA, Lund PS. Cantilever
and implant biomechanics: a review of the literature, part
1. J Prosthodont. 1994;3(1):41-46.
34. Worthington P, Bolender CL, Taylor TD. The
Swedish system of osseointegrated implants: problems and
complications encountered during a 4-year trial period. Int
J Oral Maxillofac Implants. 1987;2(2):77-84.
35. Sones AD. Complications with osseointegrated im-
plants. J Prosthet Dent. 1989;62(5):581-585.
36. Staab GH, Stewart RB. Theoretical assessment of
cross sections for cantilevered implant-supported pros-
theses. J Prosthodont. 1994;3(1):23-30.
37. English CE. Biomechanical concerns with fixed
partial dentures involving implants. Implant Dent. 1993;
2(4):221-242.
38. von Gonten AS, Medina T Jr., Woolsey GD,
Hill DR. Modifications in the design and fabrication of
mandibular osseointegrated fixed prostheses frameworks.
J Prosthodont. 1995;4(2):82-89.
39. Cox J, Zarb G. Alternative prosthodontic super-
structure designs. Swed Dent J Suppl. 1985;28:71-75.
40. Drago C. Cantilever lengths and anterior-posterior
spreads of interim, acrylic resin, full-arch screw-retained
prostheses and their relationship to prosthetic complica-
tions. J Prosthodont. 2017;26(6):502-507.
41. Rodriguez AM, Aquilino SA, Lund PS. Cantilever
and implant biomechanics: a review of the literature,
part 2. J Prosthodont. 1994;3(2):114-118.
42. Kosinski TF. Overdenture design to maximize sta-
bility and function. Dent Today. 2017;36(2):108-112.
43. Sharma S, Makkar M, Teja SS, Singh P. Implant-
supported overdenture: a review. J Pharm Biomed Sci.
2017;07(7):270-277.
44. Greenstein G, Cavallaro J Jr. Cantilevers extending
from unilateral implant-supported fixed prostheses: a re-
view of the literature and presentation of practical
guidelines. JADA. 2010;141(10):1221-1230.
45. Brunski J. Biomechanics. In: Worthington P,
Lang BR, Rubenstein JE, eds. Osseointegration in
Dentistry. 2nd ed., Hanover Park, IL: Quintessence;
2003:49-84.
795