Citation Information :
Girotra M, Yadav B, Malhotra P, Ritwal P, Singh D, Madan R. Comparative Evaluation of the Stresses on the Terminal Abutment and Edentulous Ridge in Unilateral Distal Extension Condition when Restored with Different Prosthetic Options: An FEA Analysis. Int J Prosthodont Restor Dent 2023; 13 (2):58-64.
Purpose: The purpose of this finite element analysis (FEA) was to evaluate and compare the stresses on the terminal abutment and edentulous ridge in unilateral distal extension conditions when restored with different prosthetic options.
Materials and methods: A finite element model of a unilateral maxillary edentulous arch distal to the second premolar was fabricated. The second premolar was used as a terminal abutment for three different treatment modalities, namely cast partial denture, semiprecision attachment, and flexible dentures. Three levels of loading (150, 250, and 350 N) were applied from two directions, that is, vertically (90°) and obliquely (60°), on the central fossa of the first and second molars of the prosthesis. The maximum von Mises stress distribution was recorded at two regions, that is, the terminal abutment (cervically) and the edentulous ridge. The data was divided into three groups according to the type of prosthesis. An independent t-test was used to compare the values of the three groups. Analysis of variance (ANOVA) was used to test the differences between the loading directions.
Results: The highest level of stress on the terminal abutment and edentulous ridge was noted with the flexible denture (71.39 and 93.29 MPa), followed by cast partial dentures (8.63 and 3.69 MPa), and the least stress was noted with the semi-precision attachment (3.15 and 1.57 MPa, respectively). The difference in stress levels on both abutment and ridge when the flexible denture was compared with cast partial denture and semi-precision attachment was statistically significant (p < 0.05). However, the stress levels between cast partial and semi-precision attachment were not statistically significant (p > 0.05). The stress levels increased by increasing the forces from 150 to 350 N and changing the direction of forces from vertical to oblique in all three prostheses on both the abutment and edentulous ridge.
Conclusion: Semi-precision attachment and cast partial denture did not depict any significant changes in stress levels on abutment teeth and edentulous ridge. However, flexible dentures show the highest stress levels. Hence, within the confines of the study, semi-precision attachment seems to be the most recommended treatment option, followed by cast partial dentures. Clinicians should limit flexible dentures to only provisional prostheses.
Suwal P, Singh R, Ayer A, et al. Cast partial denture versus acrylic partial denture for replacement of missing teeth in partially edentulous patients. J Dent Mater Tech 2017; 6(1):27–34. DOI: 10.22038/JDMT.2016.7841
Ahmed B, Alkhiary Y, Amin H, et al. Stress analysis of different designs of distal extension partial dentures with pier abutment: a finite element analysis. Egyptian Dent J 2015;61(2):1451–1457.
Tomar GK, Garhnayak M, Das SS, et al. Cast partial denture retained using precision attachment – a case report. IOSR J Dent Med Sci 2016;15(7):94–99. DOI: 10.9790/0853-150759499
Patrnogić V, Todorović A, Sćepanović M, et al. Free-end saddle length influence on stress level in unilateral complex partial denture abutment teeth and retention elements. Vojnosanit Pregl 2013;70(11):1015–1022. DOI: 10.2298/vsp110603028p
Sabri LA, Abdulkareem JF, Salloomi KN, et al. Finite element analysis of class II mandibular unilateral distal extension partial dentures. Proc Insti Mech Eng, Part C: J Mech Eng Sci 2022;236(17):9407–9418. DOI: 10.1177/0954406222109663
Mousa MA, Abdullah JY, Jamayet NB, et al. Biomechanics in removable partial dentures: a literature review of fea-based studies. Biomed Res Int 2021;2021:5699962. DOI: 10.1155/2021/5699962
Igarashi Y, Ogata A, Kuroiwa A, et al. Stress distribution and abutment tooth mobility of distal-extension removable partial dentures with different retainers: an in vivo study. J Oral Rehabil 1999;26(2):111–116. DOI: 10.1046/j.1365-2842.1999.00345.x.
Chen X, Mao B, Zhu Z, et al. A three-dimensional finite element analysis of mechanical function for 4 removable partial denture designs with 3 framework materials: CoCr, Ti-6Al-4V alloy and PEEK. Sci Rep 2019;9(1):13975. DOI: 10.1038/s41598-019-50363-1
Hundal M, Madan R. Comparative clinical evaluation of removable partial dentures made of two different materials in Kennedy Applegate class II partially edentulous situation. Med J Armed Forces India 2015;71(Suppl 2):S306–S312. DOI: 10.1016/j.mjafi.2012.08.020
Bhojaraju N, Srilakshmi J, Vishwanath G. Study of deflections in maxillary major connectors: a finite element analysis. J Indian Prosthodont Soc 2014;14(1):50–60. DOI: 10.1007/s13191-012-0237-3
Ramakrishnan H, Singh RG. Three-dimensional finite element analysis of the stress distribution pattern in the design modifications of U-shaped palatal major connector. Indian J Dent Res 2010;21(4): 506–511. DOI: 10.4103/0970-9290.74219
Wang HY, Zhang YM, Yao D, et al. Effects of rigid and nonrigid extracoronal attachments on supporting tissues in extension base partial removable dental prostheses: a nonlinear finite element study. J Prosthet Dent 2011;105(5):338–346. DOI: 10.1016/S0022-3913(11)60066-8
Patel H, Patel K, Thummer S, et al. Use of precision attachment and cast partial denture for long-span partially edentulous mouth-a case report. Int J Appl Dent Sci 2014;1(1):22–25.
Dogru SC, Cansiz E, Arslan YZ. A Review of finite element applications in oral and maxillofacial biomechanics. J Mech Med Biol 2018;18(2). DOI: 10.1142/S0219519418300028
Petridis H, Hempton TJ. Periodontal considerations in removable partial denture treatment: a review of the literature. Int J Prosthodont 2001;14(2):164–172.
Jain AR, Philip JM, Ariga P. Attachment-retained unilateral distal extension (Kennedy's class II modification I) cast partial denture. Int J Prosthodont Restor Dent 2012;2(3):101–107. DOI: 10.5005/jp-journals-10019-1057
Giffin KM. Solving the distal extension removable partial denture base movement dilemma: a clinical report. J Prosthet Dent 1996;76(4):347–349. DOI: 10.1016/s0022-3913(96)90536-3
Muraki H, Wakabayashi N, Park I, et al. Finite element contact stress analysis of the RPD abutment tooth and periodontal ligament. J Dent 2004;32(8):659–665. DOI: 10.1016/j.jdent.2004.07.003
Xiao W, Li Z, Shen S, et al. Influence of connection type on the biomechanical behavior of distal extension mandibular removable partial dentures supported by implants and natural teeth. Comput Methods Biomech Biomed Engin 2016;19(3):240–247. DOI: 10.1080/10255842.2015.1009450
Mendoza-Carrasco I, Hotta J, Sugio CYC, et al. Nonmetal clasp dentures: what is the evidence about their use? J Indian Prosthodont Soc 2020;20(3):278–284. DOI: 10.4103/jips.jips_459_19
Kumar N, Koli DK, Jain V, et al. Stress distribution and patient satisfaction in flexible and cast metal removable partial dentures: finite element analysis and randomized pilot study. J Oral Biol Craniofac Res 2021;11(4):478–485. DOI: 10.1016/j.jobcr.2021.06.004
Goodkind RJ. The effects of removable partial dentures on abutment tooth mobility: a clinical study. J Prosthet Dent 1973;30(2):139–146. DOI: 10.1016/0022-3913(73)90047-4
Tebrock OC, Rohen RM, Fenster RK, et al. The effect of various clasping systems on the mobility of abutment teeth for distal-extension removable partial dentures. J Prosthet Dent 1979;41(5):511–516. DOI: 10.1016/0022-3913(79)90082-9
Todorović A, Radovic K, Grbovic A, et al. Stress analysis of a unilateral complex partial denture using the finite-element method. MaterTech 2010;44(1): 41–47.
Bhathal M, Batra J, Attresh G, Sambyal S. A review on stresses-induced by removable partial dentures. Int J Contemp Dent Med Rev 2015.
Owall B. Precision attachment-retained removable partial dentures: Part 2. Long-term study of ball attachments. Int J Prosthodont 1995;8(1):21–28.
Leo HE, Wu JH, Wang CH. Biomechanical analysis of distal extension removable partial dentures with different retainers. J Dent Sci 2008;3(3):133–139.