The aim of this work was to study the biomechanical behavior of an All-on-4 implant-supported prosthesis through a finite element analysis comparing 3 different tilt degrees of the distal implants. Three-dimensional finite element models of an edentulous maxilla restored with a prosthesis supported by 4 implants were reconstructed to carry out the analysis. Three distinct configurations, corresponding to 3 tilt degrees of the distal implants (15°, 30°, and 45°) were subjected to 4 loading simulations. The von Mises stresses generated around the implants were localized and quantified for comparison. Negligible differences in von Mises stress values were found in the comparison of the 15° and 30° models. From a stress-level viewpoint, the 45° model was revealed to be the most critical for peri-implant bone. In all the loading simulations, the maximum stress values were always found at the neck of the distal implants. The stress in the distal implants increased in the apical direction as the tilt degree increased. The stress location and distribution patterns were very similar among the evaluated models. The increase in the tilt degree of the distal implants was proportional to the increase in stress concentration. The 45° model induced higher stress values at the bone-implant interface, especially in the distal aspect, than the other 2 models analyzed.
Keywords: all-on-4; atrophic edentulous maxilla; finite-element analysis; full-arch prosthesis; implant-bone interaction; tilted implants.