Fitting Accuracy and Constraint Force Measurement of Complete-Arch Implant-Supported Fixed Dental Prostheses Made from Cobalt-Chromium and Zirconia Frameworks Based on the All-on-Four Treatment Concept

The aim of this laboratory study was to evaluate the fitting accuracy of complete-arch implant-supported fixed dental prostheses (ISFDPs) and the occurrence of possible constraint forces after ISFDP fixation using the All-on-four treatment concept. A titanium model was fabricated with support posts for implants in positions 15, 12, 22, and 25. The forces acting on these posts were assessed using strain gauge half bridges. Implants (BEGO Semados^® SCX Implantat 4.1 mm × 10 mm, BEGO Implant Systems, Bremen, Germany) were fixated on top of the support posts. Based on conventional impressions and intraoral scans, two 12-unit monolithic ISFDPs made from cobalt-chromium alloy (CoCr) and zirconia (ZrO₂) were fabricated, jointed with titanium adhesive abutments (PS TiB NH, BEGO), and successively attached to the model. Constraint forces caused by ISFDP fixation were measured for each implant without external force. After testing four ISFDPs with different materials and impression techniques, four new implants were fixated (n = 10 model situations). A standard linear mixed model was used to assess horizontal and vertical constraint forces. The horizontal constraint forces acting on the implants were oriented in the oral direction, indicating that the ISFDPs were too small. The highest constraint forces were measured on implant 22 in the horizontal and vertical directions. Within the limitations of the present laboratory study, the fitting accuracy of complete-arch CoCr and ZrO₂ ISFDPs based on the All-on-four concept was sufficient for clinical use. Restorations made using conventional impressions had better fitting accuracy and reliability than those made using intraoral scans.