Biomechanical Evaluation of Cantilevered Full-Arch Implant-Supported Polymer-Based Hybrid Prostheses: A Digital Image...

Implant-Supported Fixed Prostheses (ISFPs) have become a common option for the rehabilitation of fully edentulous arches and have traditionally incorporated metallic substructures with ceramic or acrylic veneering. The rapid expansion of CAD/CAM technologies has introduced not only a range of polymer-based materials as alternatives to conventional metallic frameworks but also the possibility of the fabrication of monolithic rehabilitations. However, the evidence regarding the mechanical behavior of monolithic polymer-based full-arch rehabilitations remains limited. This study aimed to evaluate and compare the mechanical performance of monolithic polymer-based complete prostheses under static loading using Digital Image Correlation (DIC). A total of 12 specimens (3 per group) simulating an FP3 maxillary full-arch ISFP supported by four implants were milled from four materials: poly(ether ether ketone) (G1-PEEK), poly(ether ketone ketone) (G2-PEKK), poly(methyl methacrylate) (G3-PMMA), and fiber-reinforced composite (G4-FRC). All specimens were subjected to static loading up to 200 N at the incisors region, corresponding to the anterior unsupported span, and at the occlusal surface of the molars, corresponding to the most distal portion of the cantilever, using a universal testing machine. Full-field vertical displacement and strain distributions (principal tensile, compressive, and von Mises) were acquired through a stereo DIC system and analyzed using a Linear Mixed-Effects Model with Tukey's HSD post hoc comparisons (α = 0.05). All prostheses withstood the applied load without macroscopic failure. G3-PMMA exhibited the highest vertical displacement, exceeding 1000 µm in the anterior span and 1500 µm in the cantilever region, along with the greatest strain concentrations, particularly at the interproximal embrasures distal to the terminal abutment. G1-PEEK provided the lowest displacement in the anterior span. G4-FRC presented displacements similar to G1-PEEK and G2-PEKK at the distal cantilever, but the lowest tensile strains and the most homogeneous strain dissipation in both loading at the anterior unsupported span and distal cantilever. This indicated that the biomechanical performance of full-arch ISFPs is highly influenced by the polymer used. PEEK, PEKK, and FRC appear as promising alternatives to PMMA for monolithic full-arch rehabilitations.