The Biomechanics of Implant-Supported Cantilevered Fixed Partial Dentures: Systematic Review of the Literature


  • Ichraq Benazouz Fixed Prosthesis Department, Faculty of Dentistry of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco and Casablanca’s Dental Consultation and Treatment Center, CHU Ibn Rochd, Casablanca, Morocco
  • Meriem Amine Fixed Prosthesis Department, Faculty of Dentistry of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco and Casablanca’s Dental Consultation and Treatment Center, CHU Ibn Rochd, Casablanca, Morocco
  • Abderrahman Andoh Casablanca’s Dental Consultation and Treatment Center, CHU Ibn Rochd, Casablanca, Morocco and Biology and Fundamental Matieres Department, Faculty of Dentistry of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco



Partial implant supported dental prosthesis, cantilever, Biomechanics, fixed dentures, extension.


Introduction: Current implant rehabilitations must take into account prosthetic imperatives. Pre-implant planning permits to highlight some unfavorable clinical situations that compete against the ideal implant location. An alternative prosthetic design intending the use of an implant-supported cantilevered bridge may be suggested.

Purpose: The main aim of our review is to analyze the biomechanics of fixed partial implant cantilevered restorations as well as the criteria for a reliable choice of this design.

Materials and Methods: The literature research was performed using the PubMed, direct Science and Google scholar electronic databases, using the following keywords and Boolean equations: (((partial implant supported dental prosthesis) and (cantilever); ((((Biomechanics) and (fixed dentures)) and (implants)) and (cantilever)); ((((Biomechanics) and (fixed dentures)) and (implants)) and (extension)). To be selected, articles must be published between 2010 and 2020.

Results: Nine articles using various methods of stress evaluation : photoelasticimetry, strain?gauge measurement, and finite element analysis (FEA) were included in our review to analyze the biomechanics of cantilevered fixed partial implant prostheses.

Conclusion: The prognosis of cantilever implant prostheses depends on the length, location of the cantilever, the superstructure materials, the density and the size of the available bone. The prosthodontist can choose the best treatment approach by acting on the factors improving the biomechanical behavior of cantilever restorations.


Hälg GA, Schmid J, Hämmerle CH. Bone level changes at implants supporting crowns or fixed partial dentures with or without cantilevers. Clin Oral Implants Res 2008; 19: 83-990.

Palmer RM, Howe LC, Palmer PJ, Wilson R. A prospective clinical trial of single Astra Tech 4.0 or 5.0 diameter implants used to support two-unit cantilever bridges: Results after 3 years. Clin Oral Implants Res 2012; 23: 35-40.

Kunavisarut C, Lang LA, Stoner BR, Felton DA. Finite element analysis on dental implant-supported prostheses without passive fit. J Prosthodont 2002; 11: 30e40.

Stegaroiu R, Sato T, Kusakari H, Miyakawa O. Influence of restoration type on stress distribution in bone around implants: A threedimensional finite element analysis. Int J Oral Maxillofac Implants 1998; 13: 82-90.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta analyses of health care interventions: Checklist and explanations. Ann Intern Med 2015; 162: 777-84.

Lotti RS, Machado AW, Mazzieiro ET, et al. Aplicabilidade cient?fica do m´etodo dos elementos finitos. R Dental Press Ortodon Ortop Facial 2006; 11: 35-43.

Silva AAP, Teixeira MF: Implantes curtos. Revista Implant News 2009; 6: 649-653.

Wang C, Li Q, McClean C, Fan Y. Numerical simulation of dental bone remodeling induced by implant-supported fixed partial denture with or without cantilever extension. Int J Numer Method Biomed Eng 2013; 29(10): 1134-47.

Yoda N, Liao Z, Chen J, Sasaki K, Swain M, Li Q. Role of implant configurations supporting three-unit fixed partial denture on mandibular bone response: biological-data-based finite element study. J Oral Rehab 2016; 43(9): 692-701.

Kobari H, Yoda N et al. An In vivo Study on Load Distribution in Different Implant Configurations for Supporting Fixed Partial Dentures. Int J Oral Maxillofac Implants 2016; 31(5): 1049-57.

Batista VED Souza, Verri FR. Almeida DAF and al. Finite element analysis of implant-supported prosthesis with pontic and cantilever in the posterior maxilla. Comput Methods Biomech Biomed Engin 2017; 20 (6): 663-670.

Goiato MC, Shibayama R, Gennari Filho H, de Medeiros RA, Pesqueira AA, dos Santos DM, et al. Stress distribution in implant-supported prostheses using different connection systems and cantilever lengths: digital photoelasticity. J Med Eng Technol 2016; 40(2): 35-42.

Mer?ç G, Erkmen E, Kurt A, Eser A, özden A. Biomechanical effects of two different collar implant structures on stress distribution under cantilever fixed partial dentures. Acta Odontol Scand 2011; 69(6): 374-84.

Sallam H, Sayed Kheiralla L, Aldawakly A. Microstrains Around Standard and Mini Implants Supporting Different Bridge Designs. J Oral Implantol 2012; 38(3): 221-9.

Borie E, Augusta Orsi I, Yoshito Noritomi P, Takanori Kemmoku D. Three-Dimensional Finite Element Analysis of the Biomechanical Behaviors of Implants with Different Connections, Lengths, and Diameters Placed in the Maxillary Anterior Region. Int J Oral Maxillofac Implants 2016; 31(1): 101-10.

Alencar SMM, Lorenna Bastos LVN, et al. FEA of Peri-Implant Stresses in Fixed Partial Denture Prostheses With Cantilevers. J Prosthodont 2017; 26(2): 150-155.

Lin D, Li Q, Li W, Swain M. Dental implant induced bone remodeling and associated algorithms. J Mech Behav Biomed Mater 2009; 2: 410-432.

Kim P, Ivanovski S, Latcham N, Mattheos N. The impact of cantilevers on biological and technical success outcomes of implant-supported fixed partial dentures. A retrospective cohort study. Clin Oral Impl Res 2014; 25: 175-184.

Freitas da Silva EV, Dos Santos DM. Does the Presence of a Cantilever Influence the Survival and Success of Partial Implant-Supported Dental Prostheses? Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants 2018; 33(4): 815-823.

Romeo E, Tomasi C, Finini I, Casentini P, Lops D. Implant-supported fixed cantilever prosthesis in partially edentulous jaws: A cohort prospective study. Clin Oral Implants Res 2009; 20: 1278-1285.

Pjetursson BE, Thoma D, Jung R, Zwahlen M, & Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clinical Oral Implants Research 2012; 23: 22-38.

Bruno RC, Kisch J, Larsson C. Retrospective clinical evaluation of 2- to 6-unit implant-supported fixed partial dentures: Mean follow-up of 9 years. Clin Implant Dent Relat Res 2020; 22(2): 201-212.

Romanos GE, Gupta B, Gaertner K, Nentwig GH. Distal cantilever in full-arch prostheses and immediate loading: A retrospective clinical study. Int J Oral Maxillofac Implants 2014; 29: 427-431.

Kreissl ME, Gerds T, Muche R, Heydecke G, Strub JR. Technical complications of implant-supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years. Clin Oral Implants Res 2007; 18: 720-726.

Rangert B, Jemt T, Jorneus L. Forces and moments on Branemark implants. International Journal of Oral &Maxillofacial Implants 1989; 4: 241-247.

Romeo, E., Lops, D., Margutti, E., Ghisolfi, M., Chiapasco, M. & Vogel, G. Implant-supported fixed cantilever prostheses in partially edentulous arches. A seven-year prospective study. Clinical Oral Implants Research 2003; 14: 303-311.

Suedam V, Moretti Neto RT. Effect of cantilever length and alloy framework on the stress distribution in peri-implant area of cantilevered implant-supported fixed partial dentures. J Appl Oral Sci 2016; 24(2): 114-20.

Cehreli MC, Akca K. Narrow diameter implants as terminal support for occlusal three-unit FPDs: biomechanical analysis. Int J Periodont Restor Dent 2004; 24: 513-519.

Matsushita Y, Kitoh M, Zutak MI, Ikeda H, Suetsugu T. Two-dimensional FEM analysis of hydroxyl apatite implants: diameter effects on stress distribution. J Oral Implantol 1990; 16: 611.

Flanagan D. Fixed partial dentures and crowns supported by very small diameter dental implants in compromised sites. Implant Dent 2008; 17(2): 182-188.

Pellizzer EP, de Mello CC, Santiago Junior JF, de Souza Batista VE, de Faria Almeida DA, Verri FR. Analysis of the biomechanical behavior of short implants: the photoelasticity method. Mater Sci Eng C Mater Biol Appl 2015; 55: 187-192.

Lemos CA, Ferro-Alves ML, Okamoto R, Mendonca MR, Pellizzer EP. Short dental implants versus standard dental implants placed in the posterior jaws: a systematic review and meta-analysis. J Dent 2016; 47: 8-17.

Keith SE, Miller BH, Woody RD, et al. Marginal discrepancy of screw-retained and cemented metal-ceramic crowns on implant abutments. Int J Oral Maxillofac Implants 1999; 14: 369-37834.

Guichet DL, Caputo AA, Choi H, et al. Passivity of fit and marginal opening in screw- or cement-retained implant fixed partial denture designs. Int J Oral Maxillofac Implants 2000; 15: 239-246

Verri FR, Batista VE, Santiago JF Jr, Almeida DA, Pellizzer EP. Effect of crown-to-implant ratio on peri-implant stress: a finite element analysis. Mater Sci Eng C Mater Biol Appl 2014; 45: 234-240.