Assessment of the efficacy of posterior extra-short implant support for an interforaminal implant-supported fixed full-arch mandibular prosthesis

  • H. Can Tükel DDS PhD, Assistant Professor, Çukurova University, Department of Oral and Maxillofacial Surgery, Adana,Turkey, Turkey.
  • S. Kucukkurt | DDS PhD, Assistant Professor, Istanbul Aydın University, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey, Turkey.


Aim The purpose of the present study was to determine whether it is useful to support a fixed full-arch prosthesis supported by interforaminal implants, with extra-short implants (4 mm) in the posterior region in order to eliminate the cantilever extensions, in posterior atrophic mandible cases.

Methods Six different models including three or four interforaminal implants with or without support of posterior extra-short implants were formed. Straumann tissue-level implants (4.1x12mm and 4.1x4mm) were modeled for this study. Spherical loadings from canine and molar regions were applied to evaluate tension, compression, and von Mises stresses by implementing finite element analysis.

Results In most conditions, four interforaminal implant supports provide balanced stress distributions, on the other hand, only three interforaminal implants were found to be insufficient biomechanically. The support of interforaminal implants with extra-short implants in the posterior region did not show the expected contribution, especially against the forces in the canine region. Also, the placement of four posterior extra-short implants does not make significant difference compared to the placement of two extra-short implants.

Conclusions Implant-supported fixed prosthetic rehabilitation with cantilever extension of an edentulous mandible supported by four implants in the interforaminal region reached the best biomechanical results of the present study.




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Author Biography

H. Can Tükel, DDS PhD, Assistant Professor, Çukurova University, Department of Oral and Maxillofacial Surgery, Adana,Turkey




1. de NDFJ, Pecorari VGA, Martins CB, Del Fabbro M, Casati MZ. Short implants versus bone augmentation in combination with standard-length implants in posterior atrophic partially edentulous mandibles: systematic review and meta-analysis with the Bayesian approach. Int J Oral Maxillofac Surg. 2018.
2. Pieri F, Forlivesi C, Caselli E, Corinaldesi G. Short implants (6mm) vs. vertical bone augmentation and standard-length implants (>/=9mm) in atrophic posterior mandibles: a 5-year retrospective study. Int J Oral Maxillofac Surg. 2017;46:1607-1614.
3. Abayev B, Juodzbalys G. Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques. J Oral Maxillofac Res. 2015;6:e2.
4. Moraschini V, Velloso G, Luz D, Cavalcante DM, Barboza Edos S. Fixed Rehabilitation of Edentulous Mandibles Using 2 to 4 Implants: A Systematic Review. Implant Dent. 2016;25:435-444.
5. Krennmair G, Seemann R, Weinlander M, Krennmair S, Piehslinger E. Clinical outcome and peri-implant findings of four-implant-supported distal cantilevered fixed mandibular prostheses: five-year results. Int J Oral Maxillofac Implants. 2013;28:831-840.
6. Malo P, de Araujo Nobre M, Lopes A. The prognosis of partial implant-supported fixed dental prostheses with cantilevers. A 5-year retrospective cohort study. Eur J Oral Implantol. 2013;6:51-59.
7. Turkyilmaz I, Jones JD. Long term success of 6 implants supporting a mandibular screw-retained fixed dental prosthesis: a clinical report. J Prosthet Dent. 2012;107:280-283.
8. Hatano N, Yamaguchi M, Yaita T, Ishibashi T, Sennerby L. New approach for immediate prosthetic rehabilitation of the edentulous mandible with three implants: a retrospective study. Clin Oral Implants Res. 2011;22:1265-1269.
9. Engstrand P, Grondahl K, Ohrnell LO, Nilsson P, Nannmark U, Branemark PI. Prospective follow-up study of 95 patients with edentulous mandibles treated according to the Branemark Novum concept. Clin Implant Dent Relat Res. 2003;5:3-10.
10. Branemark PI, Engstrand P, Ohrnell LO, Grondahl K, Nilsson P, Hagberg K, et al. Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999;1:2-16.
11. Monje A, Fu JH, Chan HL, Suarez F, Galindo-Moreno P, Catena A, et al. Do implant length and width matter for short dental implants (<10 mm)? A meta-analysis of prospective studies. J Periodontol. 2013;84:1783-1791.
12. Schwartz SR. Short implants: are they a viable option in implant dentistry? Dent Clin North Am. 2015;59:317-328.
13. Pommer B, Mailath-Pokorny G, Haas R, Buseniechner D, Millesi W, Furhauser R. Extra-short (< 7 mm) and extra-narrow diameter (< 3.5 mm) implants: a meta-analytic literature review. Eur J Oral Implantol. 2018;11 Suppl 1:S137-S146.
14. Calvo-Guirado JL, Morales-Melendez H, Perez-Albacete Martinez C, Morales-Schwarz D, Kolerman R, Fernandez-Dominguez M, et al. Evaluation of the Surrounding Ring of Two Different Extra-Short Implant Designs in Crestal Bone Maintanence: A Histologic Study in Dogs. Materials (Basel). 2018;11.
15. Shah SN, Chung J, Kim DM, Machtei EE. Can extra-short dental implants serve as alternatives to bone augmentation? A preliminary longitudinal randomized controlled clinical trial. Quintessence Int. 2018;49:635-643.
16. Bordin D, Bergamo ETP, Bonfante EA, Fardin VP, Coelho PG. Influence of platform diameter in the reliability and failure mode of extra-short dental implants. J Mech Behav Biomed Mater. 2018;77:470-474.
17. Slotte C, Gronningsaeter A, Halmoy AM, Ohrnell LO, Mordenfeld A, Isaksson S, et al. Four-Millimeter-Long Posterior-Mandible Implants: 5-Year Outcomes of a Prospective Multicenter Study. Clin Implant Dent Relat Res. 2015;17 Suppl 2:e385-395.
18. Slotte C, Gronningsaeter A, Halmoy AM, Ohrnell LO, Stroh G, Isaksson S, et al. Four-millimeter implants supporting fixed partial dental prostheses in the severely resorbed posterior mandible: two-year results. Clin Implant Dent Relat Res. 2012;14 Suppl 1:e46-58.
19. Ozan O, Kurtulmus-Yilmaz S. Biomechanical Comparison of Different Implant Inclinations and Cantilever Lengths in All-on-4 Treatment Concept by Three-Dimensional Finite Element Analysis. Int J Oral Maxillofac Implants. 2018;33:64-71.
20. Anitua E, Alkhraisat MH, Orive G. Novel technique for the treatment of the severely atrophied posterior mandible. Int J Oral Maxillofac Implants. 2013;28:1338-1346.
21. Pimentel MJ, Silva WJ, Del Bel Cury AA. Short implants to support mandibular complete dentures - photoelastic analysis. Braz Oral Res. 2017;31:e18.
22. Atieh MA, Zadeh H, Stanford CM, Cooper LF. Survival of short dental implants for treatment of posterior partial edentulism: a systematic review. Int J Oral Maxillofac Implants. 2012;27:1323-1331.
23. Han J, Zhang X, Tang Z, Zhang L, Shi D, Meng H. A prospective, multicenter study assessing the DENTSPLY Implants, OsseoSpeed() TX, length 6 mm in the posterior maxilla and mandible: a 1-year follow-up study. Clin Oral Implants Res. 2016;27:452-457.
24. Tabrizi R, Arabion H, Aliabadi E, Hasanzadeh F. Does increasing the number of short implants reduce marginal bone loss in the posterior mandible? A prospective study. Br J Oral Maxillofac Surg. 2016;54:731-735.
25. Seemann R, Marincola M, Seay D, Perisanidis C, Barger N, Ewers R. Preliminary results of fixed, fiber-reinforced resin bridges on four 4- x 5-mm ultrashort implants in compromised bony sites: a pilot study. J Oral Maxillofac Surg. 2015;73:630-640.
26. Cannizzaro G, Felice P, Soardi E, Ferri V, Leone M, Lazzarini M, et al. Immediate loading of 2(all-on-2) versus 4 (all-on-4) implants placed with a flapless technique supporting mandibular cross-arch fixed prostheses: 1-year results from a pilot randomised controlled trial. Eur J Oral Implantol. 2013;6:121-131.
27. Oliva J, Oliva X, Oliva JD. All-on-three delayed implant loading concept for the completely edentulous maxilla and mandible: a retrospective 5-year follow-up study. Int J Oral Maxillofac Implants. 2012;27:1584-1592.
28. Hatano N, Yamaguchi M, Suwa T, Watanabe K. A modified method of immediate loading using Branemark implants in edentulous mandibles. Odontology. 2003;91:37-42.
29. Heydecke G, Zwahlen M, Nicol A, Nisand D, Payer M, Renouard F, et al. What is the optimal number of implants for fixed reconstructions: a systematic review. Clin Oral Implants Res. 2012;23 Suppl 6:217-228.
30. Simamoto Junior PC, da Silva-Neto JP, Novais VR, de Arruda Nobilo MA, das Neves FD, Araujo CA. Photoelastic stress analysis of mandibular fixed prostheses supported by 3 dental implants. Implant Dent. 2014;23:704-709.
31. Fazi G, Tellini S, Vangi D, Branchi R. Three-dimensional finite element analysis of different implant configurations for a mandibular fixed prosthesis. Int J Oral Maxillofac Implants. 2011;26:752-759.
32. Correa S, Ivancik J, Isaza JF, Naranjo M. Evaluation of the structural behavior of three and four implant-supported fixed prosthetic restorations by finite element analysis. J Prosthodont Res. 2012;56:110-119.
33. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber HP. Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin Oral Implants Res. 2009;20:601-607.
34. Torrecillas-Martinez L, Monje A, Lin GH, Suarez F, Ortega-Oller I, Galindo-Moreno P, et al. Effect of cantilevers for implant-supported prostheses on marginal bone loss and prosthetic complications: systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014;29:1315-1321.
35. Stafford GL. Survival rates of short-span implant-supported cantilever fixed dental prostheses. Evid Based Dent. 2010;11:50-51.
36. Balevi B. Implant-supported cantilevered fixed partial dentures. Evid Based Dent. 2010;11:48-49.
37. Zurdo J, Romao C, Wennstrom JL. Survival and complication rates of implant-supported fixed partial dentures with cantilevers: a systematic review. Clin Oral Implants Res. 2009;20 Suppl 4:59-66.
38. Anderson JD. Ten-year survival rate for cantilevered fixed partial dentures. Evid Based Dent. 2005;6:96-97.
39. Ogawa T, Dhaliwal S, Naert I, Mine A, Kronstrom M, Sasaki K, et al. Effect of tilted and short distal implants on axial forces and bending moments in implants supporting fixed dental prostheses: an in vitro study. Int J Prosthodont. 2010;23:566-573.
Dental implant, finite element analysis, full mouth rehabilitation, interforaminal, extra-short implant
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How to Cite
Tükel, H. C., & Kucukkurt, S. (2020). Assessment of the efficacy of posterior extra-short implant support for an interforaminal implant-supported fixed full-arch mandibular prosthesis. Journal of Osseointegration, 12(2), 181-188.