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Optimizing Dental Implant Success: Exploring Stress Distribution in All-on-4 Concept

In the realm of modern dentistry, the All-on-4 concept has gained significant traction for its high success rates in full-arch fixed prostheses. A recent study aimed to delve into this success by investigating the stress distribution within the All-on-4 system, particularly focusing on the impact of tilted distal implants and varying cantilever lengths. 

The success of full-arch fixed prostheses (FFPs) supported by implants is well-established, with high patient satisfaction rates. However, the restoration of atrophic edentulous mandibles presents challenges due to anatomical obstacles such as the maxillary sinus and mental foramen. 

The All-on-4 concept, introduced by Malo et al., aimed to address these limitations by using tilted implants in posterior regions to allow longer implants and reduce cantilever extensions. This study seeks to enhance our understanding of stress distribution in All-on-4 systems using a novel approach involving photoelastic stress analysis and computer-aided design (CAD) combined with rapid prototyping (RP).

dental researcher's desk

Study Approach and Methodology

The study involved creating 3D models of edentulous mandibles using CT scans and reconstructing these models using CAD software. Various implant configurations were simulated, and stress analysis was performed using photoelastic acrylic resin models. 

Distally inclined implant holes were introduced into the models using Mimic and Geomagic Studio software. Photoelastic models were then built using a rapid prototyping technique, enabling accurate representation of implant placement and inclination. Cobalt-chromium alloy frameworks were fabricated to mimic the implant system, allowing for precise loading simulation.

Key parameters like implant inclination and cantilever length were manipulated to understand their impact on stress distribution.

Key Findings

  • Tilted Implants Reduce Stress: The research confirmed that tilted distal implants in the All-on-4 configuration result in reduced stress levels compared to vertically placed implants. This finding holds promise for patients with atrophic mandibles, as tilted implants can avoid anatomical obstacles and decrease surgical complexity.
  • Cantilever Length Matters: The study demonstrated that cantilever length plays a pivotal role in stress distribution. As cantilever length increased, stress around the implants also increased. This insight is vital in planning implant-supported restorations to minimize peri-implant stresses and potential complications.
  • CAD and RP for Accurate Modeling: The research highlighted the successful use of CAD and RP in creating precise photoelastic models. This approach allows for controlled modifications, accurate implant positioning, and better understanding of stress patterns around dental implants.

dentist reviewing x-rays


The research revealed intriguing insights into stress distribution around dental implants. Single tilted implants and distal implants in All-on-4 configurations showed higher stress levels around the implant compared to vertically placed implants. Interestingly, the stress distribution was influenced by the inclination of the implant. 

The findings of this study have implications for dental implant design and procedure. Tilted implants, especially in the All-on-4 configuration, exhibited favorable stress distribution characteristics. This information can guide clinicians in optimizing implant placement to achieve better load distribution and implant longevity. 

Varying cantilever lengths impacted stress distribution. The study showed that cantilever length played a crucial role in stress reduction, suggesting that shorter cantilevers result in decreased peri-implant stress. Moreover, the study's innovative approach, utilizing CAD and RP for photoelastic model construction, offers a promising avenue for future biomechanical

Clinical Implications

The study's conclusions offer actionable insights for dental practitioners:

  • Enhanced Implant Planning: Dentists can now consider the impact of both implant inclination and cantilever length when planning implant-supported restorations. This can result in better patient outcomes and reduced complications.
  • Preference for Tilted Implants: When dealing with atrophic mandibles, choosing tilted implants in an All-on-4 configuration can provide a reliable treatment option. This minimizes surgical complexity, reduces cantilever lengths, and maintains optimal stress distribution.

dental model with implants


This research, led by Qi Wang, Zhen-zhen Zhang, Shi-zhu Bai, and Shao-feng Zhang, is a significant contribution to the field of dental implantology. The study employed advanced techniques to explore stress distribution in dental implants, shedding light on the impacts of implant inclination and cantilever length.

The use of tilted implants within the All-on-4 concept demonstrated favorable stress patterns, indicating its potential for enhancing implant longevity and success. Additionally, the investigation showcased the power of CAD and RP in creating accurate and customizable photoelastic models for biomechanical studies.


Credit goes to the researchers involved in this study: Qi Wang, Zhen-zhen Zhang, Shi-zhu Bai, and Shao-feng Zhang. The study was published by the National Center for Biotechnology Information (NCBI) for more details, refer to the original research article published here. 

The study's findings offer valuable insights for dental professionals seeking to optimize implant designs and procedures for improved patient outcomes.Dental practitioners and researchers alike are encouraged to delve deeper into the study for a comprehensive understanding of the methodologies and results. This research brings us closer to refining implant practices and ensuring better outcomes for patients in need of comprehensive dental solutions.

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