Effect of varying the vertical dimension of connectors of cantilever cross-arch fixed dental prostheses in patients with severely reduced osseous support: a three-dimensional finite element analysis.

STATEMENT OF PROBLEM: Inadequate dimensioning of the connectors in a cantilever cross-arch fixed dental prosthesis (FDP) in perioprosthetic patients jeopardizes the prognosis of the restoration. PURPOSE: The purpose of this study was to investigate the effect of increasing the vertical dimension (VD) on the maximum stress developed within the connectors during the static loading of a cross-arch FDP extended as a 1- and 2-unit cantilever. MATERIAL AND METHODS: Six digital models were developed, derived from a 3-dimensional (3-D) initial model. In the initial model, the teeth were prepared for metal ceramic restorations and splinted with a cross-arch FDP, extended as a 1- or 2-unit cantilever. The VDs of the connectors proximal to the retaining abutment were 3, 4, or 5 mm. A 3-D finite element analysis (FEA) was performed. RESULTS: The VD increase, from 3 to 4 mm and from 3 to 5 mm, of the connector distal to the retaining abutment, for each FDP, presented a maximum stress value decrease of approximately 25% and 48%, respectively. The similar VD increase of the connector mesial to the retaining abutment, for each FDP, resulted in relatively smaller stress changes. For the 2-unit cantilever restoration, the stress decreases were approximately 9% and 15%, respectively, whereas in the 1-unit cantilever restoration, the decrease was about 10% for the 4-mm connector. Further increase of the VD to 5 mm did not relieve the peak stress. The highest stress value was measured on the 3-mm connector distal to the retaining abutment in the 2-unit cantilever restoration. Despite the VD increase, the connectors proximal to the retaining abutment still developed the highest stress values of all the connectors for every model. CONCLUSIONS: The connector with the highest risk of failure is the 3-mm connector distal to the retaining abutment of the 2-unit cantilever restoration. Increasing the vertical dimension is beneficial for the connector distal to the retaining abutment, while the resultant stress changes are not substantial for the connectors mesial to the retaining abutment. (J Prosthet Dent 2010;103:91-100).

Effect of severely reduced bone support on the stress field developed within the connectors of three types of cross-arch fixed partial dentures.

STATEMENT OF PROBLEM: Increased technical failure has been reported for cross-arch fixed partial dentures (FPDs), particularly for cantilever units with minimum osseous support. PURPOSE: The purpose of this study was to investigate the effect of severely reduced bone support on the stress field developed within the connectors for 3 types of cross-arch FPDs. MATERIAL AND METHODS: Six digital parametric models were developed, derived from a 3-dimensional (3-D) initial model. The latter simulated a human mandible, dentate bilaterally to second premolars, with normal height of alveolar bone. In the initial model, the teeth were prepared and splinted with a cross-arch FPD bilaterally with one of the following: no cantilever, 1-unit cantilever, or 2-unit cantilever. All structures were obtained from computed tomography (CT)-scan images or constructed in 3-D computer-aided design (CAD) and reverse engineering environments. A 3-D finite element analysis (3-D FEA) was performed. RESULTS: The reduction of the alveolar bone in the no-cantilever FPD model caused a greater increase of stress in the region of connectors among the splinted teeth in comparison to the 1- and 2-unit cantilever FPD model. The stress state within the connectors of the cantilever segment remained constant. The connectors proximal to the retaining abutment demonstrated the highest stress values, independent of the osseous support. The stress values in the region of the same connectors in the 2-unit cantilever restoration were almost double, compared to the 1-unit cantilever model. Decreasing the osseous level in the 1- and 2-unit cantilever FPD models caused milder stress distribution and magnitude in the region of connectors among the splinted teeth. CONCLUSIONS: The stress field developed within the connectors of the cantilever segment is independent of the osseous level. The stress field within the connectors among splinted teeth depends on the osseous support and both the presence and length of the cantilever segment. Furthermore, this study indicates that adding a cantilever segment has a positive effect on the stress behavior of the splinted teeth connectors in situations of reduced osseous support.