Optimizing Edentulous Mandible Rehabilitation: A Biomechanical Evaluation Of Three Implant-Supported Fixed Restoration Techniques
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Accepted: 8 September 2025
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Objective
This study aimed to evaluate the biomechanical performance of different implant configurations for three-implant-supported rehabilitation of the edentulous mandible using three-dimensional finite element analysis. Specifically, conventional vertical bone-level and tissue-level implants were compared with the Trefoil system and the All-on-3 configuration that incorporates posteriorly tilted implants.
Materials and Methods
A patient-specific mandibular model was reconstructed from cone-beam computed tomography data. Four implant-supported full-arch scenarios were simulated: three bone-level implants (3BL), three tissue-level implants (3TL), the Trefoil system (TRF), and the All-on-3 configuration (ALL3). Prostheses were standardized with identical emergence profiles and bilateral cantilever extensions. A vertical occlusal load of 100 N was applied through a spherical body mimicking a food bolus. Stress distribution in cortical bone, trabecular bone, and implant structures was assessed using finite element analysis software.
Results
The All-on-3 configuration produced the highest compressive and tensile stresses in both peri-implant bone and implant components. Bone-level designs generally resulted in greater stress accumulation, particularly in cortical bone. In contrast, tissue-level implants demonstrated more favorable stress distribution. Among all models, the Trefoil system consistently exhibited the lowest stress concentrations, reflecting its geometric and prosthetic design advantages.
Conclusion
Vertically positioned tissue-level implants and the Trefoil system demonstrated superior biomechanical performance in three-implant-supported mandibular rehabilitations with cantilever extensions. Conversely, the All-on-3 design with posteriorly tilted implants was associated with increased stress levels that may negatively impact long-term prosthetic stability. Careful selection of implant type, diameter, and angulation is therefore essential for optimizing treatment outcomes in reduced-implant full-arch rehabilitation.
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