Biomechanical Effects of Horizontal, Vertical, and Combined Misfits in Full-Arch Implant-Supported Titanium Frameworks: A Three-Dimensional Finite Element Analysis.

This study evaluated the effects of misfit type, magnitude, and location on the stress distribution in full-arch screw-retained implant frameworks. A maxillary finite element model with four implants was analyzed under 16 scenarios, characterized by horizontal misfits of 10, 50, 100, and 200 µm; vertical misfits of 10 and 100 µm; and combined 10-10 and 100-100 µm misfits, each positioned anteriorly or posteriorly. Forced seating was simulated using prescribed displacement; no occlusal load or screw preload was applied. Von Mises stresses were evaluated in the framework, occlusal screws, and implants, and principal stresses were assessed in peri-implant bone. Framework stress increased with horizontal misfit magnitude. When the same numerical misfit value (10 or 100 µm) was applied at the same location under otherwise identical model conditions, vertical misfit produced higher framework stress than horizontal misfit, indicating a direction-dependent response associated with different seating deformation modes. The posterior 100-100 µm combined misfit produced the maximum framework (356 MPa), occlusal screw (193 MPa), and implant (250 MPa) stresses. In contrast, the maximum principal stress peaked at the posterior bone site with the anterior 200 µm horizontal misfit (V0 H200 A; 77 MPa), while the most negative minimum principal stress occurred at the posterior bone site with the posterior 200 µm horizontal misfit (V0 H200 P; -52 MPa). Among the tested scenarios, combined misfits yielded the highest framework and screw stresses, whereas implant and bone responses depended on the magnitude and location of the misfit. These findings indicate that the types, magnitudes, and locations of misfits should be considered during framework-fit assessments, with particular attention to combined misfits, before definitive seating.