Biomechanical considerations in osseointegrated prostheses.

On the basis of the previous discussions, several conclusions may be drawn. 1. The close apposition of bone to the titanium implant is the essential feature that allows a transmission of stress from the implant to the bone without any appreciable relative motion or abrasion. The absence of any intermediate fibrotic layer allows stress to be transmitted without any progressive change in the bond or contact between the bone and implant. 2. The use of a threaded screw provides a form of interlocking with the bone on a macroscopic scale that allows full development of the strength of the bone in shear or compression. A smooth, cylindrical implant may require an adhesive bond for satisfactory performance, but a screw shape is able to work as long as the apposition of bone and implant is close, whether or not a true adhesive bond is developed. 3. The distribution of a vertical or lateral load applied to a fixed partial denture depends on the number, arrangement, and stiffness of abutment fixtures used, as well as the form and stiffness of the fixed prosthesis itself. In general a stiff fixed partial denture will distribute loads to several fixtures more effectively. A flexible prosthesis may be adequate if the strength developed by each fixture is able to carry the full load that is applied. Cantilevered ends of a fixed partial denture increases the loading on the first screw nearest the cantilevered end. Moderate overhangs may be tolerated if the fixtures are sufficiently strong. 4. A tight connection of the fixed partial denture to fixtures provides a combined structure that can act in concert with the bone to provide a greater strength than that of the fixture or the jaw bone alone. 5. The osseointegrated implant provides a direct contact with bone and therefore will transmit any stress waves or shocks applied to the fixtures. For this reason it is advisable to use a shock-absorbing material such as acrylic resin in the form of acrylic resin artificial teeth in the fixed partial denture. This arrangement allows for the development of a stiff and strong substructure with adequate shock protection on its outer surface.