Treatment Planning the Edentulous Mandible. Review of Biomechanical and Clinical Considerations: An Update

Purpose: This review article evaluated biomechanical studies, finite element analyses, and clinical papers on the prosthetic and surgical principles for the survival of implants when reconstructing the edentulous mandible, including the use of a three-implant-supported fixed prosthesis. Materials and Methods: A comprehensive search of studies published from 1983 to December 2017 listed in the PubMed/MEDLINE databases was performed. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Results: The initial database search yielded 942 titles. After filtering, 157 abstracts were selected, with 68 articles considered relevant and included. Consensus among authors was identified in regard to the number and the distribution of implants, limiting or eliminating distal cantilevers, and the principles of biomechanical loading of a cross-arch splinted prosthesis. Conclusion: The result of this review suggests that reconstruction of the edentulous mandible with a fixed prosthesis using three, four, or six implants is a viable treatment option. However, when using three implants, wider-diameter implants are recommended for favorable force control. Keywords: ad modum Brånemark, biomechanics, graftless solution, implant, mandible