Reduction of Implant Loading With Therapeutic Biomechanics

Abstract

All physiologic biomechanical processes are interrelated and, therefore, reactive, which produces an accumulative effect that can cause implant overload. A new approach called "therapeutic biomechanics" suggests using corrective procedures to reduce implant loading. The head of the implant is positioned as close to the midline of the restoration as possible. Implant inclination may be required, but it produces less torque (moment) than horizontal implant offset. Posterior cross occlusion should be used where possible to decrease horizontal implant offset. Angulated, or reangulated abutments provide access or parallelism as needed. The posterior cusp inclination should be markedly reduced. When a vertical overlap is present anteriorly, a horizontal stop on the maxillary lingual surface redirects harmful lateral force to be vertical toward the implant and supporting bone. Because of physiologic variability, creating a modified centric occlusion that contains a 1.5-mm fossa will produce vertical resultant force within this range of motion rather than lateral force.