Comparison between all-on-four and all-on-six treatment concepts on stress distribution for full-mouth rehabilitation using three-dimensional finite element analysis: A biomechanical study

Aishwarya Pandey; Farhan Durrani; Sanjay Kumar Rai; Nishant Kumar Singh; Preeti Singh; Rati Verma; Jitendra Kumar

doi:10.4103/jisp.jisp_278_22

Comparison between all-on-four and all-on-six treatment concepts on stress distribution for full-mouth rehabilitation using three-dimensional finite element analysis: A biomechanical study

J Indian Soc Periodontol. 2023 Mar-Apr;27(2):180-188. doi: 10.4103/jisp.jisp_278_22. Epub 2023 Mar 4.

Authors

Aishwarya Pandey¹, Farhan Durrani¹, Sanjay Kumar Rai², Nishant Kumar Singh³, Preeti Singh¹, Rati Verma², Jitendra Kumar³

Affiliations

¹ Division of Periodontology, Faculty of Dental Science, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
² Division of Periodontology, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
³ Department of Biomedical Engineering, National Institute of Technology, Raipur, Chhattisgarh, India.

Abstract

Purpose: The current study intended to provide a comparison of biomechanical behaviors of two different treatment concepts for full-mouth rehabilitation with dental implants placed according to the "All-on-four" concept and "All-on-six" concept with analysis of the stress patterns of the implant support system using three-dimensional finite element analysis (FEA).

Materials and methods: The edentulous mandible was treated with two different implant designs. "All-on-Four" implant placement concept was used in Model 1 with two central axial implants and two distally tilted implants at 17° and in Model 2, "All-on-Six" concept was applied with six vertically placed implants. Individual vertical and horizontal load of 100 N and oblique load of 141 N at 45° was applied to all implants. To evaluate and compare the results in terms of maximum principal stress, we used FEA.

Results: All-on-six showed smaller maximum principal stress values on the cortical bone and implants. However, maximum principal stress values obtained on trabecular bone was smaller in the All-on-four design for vertical and horizontal loading conditions.

Conclusions: The All-on-six approach showed more favorable biomechanical behavior.

Keywords: All-on-four; all-on-six; finite element analysis; maximum principal stress; tilted implants.