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The distribution of stresses in bone, implants, and prosthesis were analyzed via three-dimensional finite element modeling in different implant configurations for a fixed implant-supported prosthesis in an edentulous mandible.A finite element model was created with data obtained from computed tomographic scans of a human mandible. Anisotropic characteristics for cortical and cancellous bone were incorporated into the model. Six different configurations of intraforaminal implants were tested, with the number of implants varying from three to five and the distal implants inserted either parallel to the other implants or tilted distally by 17 or 34 degrees. A prosthetic structure connecting the implants was designed, with 20-mm posterior cantilevers for the parallel implant configurations, and a load of 200 N was applied to the distal portion of the cantilevers. Stresses were measured at the level of the implant, the prosthetic structure, and the bone. Bone-level stresses were analyzed at the implant-bone interface, at the external cortical bone surface, distal to the terminal implant, and in the cancellous bone along the implant body.A three-parallel-implant configuration resulted in higher stress in the implant and bone than configurations with four or five parallel implants. Configurations with the distal implants tilted resulted in a more favorable stress distribution at all levels.In parallel-implant configurations for fixed implant-supported mandibular prostheses, four and five implants resulted in similar stress distribution in the bone, framework, and implants. A distribution of four implants with the distal implants tilted 34 degrees (ie, the "All-on-Four" configuration) resulted in a favorable reduction of stresses in the bone, framework, and implants.

The study evaluated in vitro the retention force and the wear resistance over simulated function of four matrix components of ball attachments for implant-retained overdentures.Four types of matrices for ball attachments were evaluated in a fatigue study simulating 5500 cycles of insertion and removal. The matrices used were (1) a Teflon matrix supported by a metal housing, (2) a titanium matrix, (3) a gold alloy matrix, (4) an O-ring matrix using the red color ring for medium retention. Dimensional changes of the ball attachments were investigated with a profilometer.The Teflon matrices showed an increase of 27% in retention at 5500 cycles while the gold alloy matrices showed an increase of 50% in retention in the first 500 cycles and remained relatively stable up to 5500 cycles. On the other hand, titanium matrices and O-ring matrices exhibited progressive loss of retention ending with 68% and 75% of retention loss, respectively, at 5500 cycles. Dimensional analysis by profilometer revealed significant wear on the ball attachment only for titanium matrixes.Gold alloy and Teflon matrices showed the highest retention values without retention loss after 3 years of simulated function. Titanium and O-ring matrices presented a continuous loss of retention with the highest wear on the ball attachments when combined with the titanium matrix.