Evaluación del efecto de las condiciones de diseño y técnica quirúrgica sobre la interfaz hueso-implante y la subestructura de prótesis híbridas implantosoportadas para la generación y validación de un protocolo clínico de rehabilitación oral en pacientes totalmente edéntulos de maxilar inferior

Abstract

The oral rehabilitation of fully edentulous patients using implant-supported hybrid prostheses presented biomechanical challenges associated with load distribution, occlusal stability, and the structural behavior of the prosthetic substructure, which motivated the integrated evaluation of the materials, geometries, and surgical techniques used for their design. To understand the influence of these variables on the bone–implant interface and on the mechanical response of implantsupported bars in the mandible, in silico computational analyses were conducted using the finite element method, allowing the comparison of multiple combinations under a standardized functional occlusal scheme. The numerical results were subsequently subjected to expert validation to ensure clinical and biomechanical coherence with the patterns observed in mandibular rehabilitations using four straight implants. Additionally, in vitro tests were carried out to characterize the performance of the selected substructures, enabling comparison between the experimental findings and the predictions of the computational model. The integrated analyses revealed significant variations in the stresses transmitted to cortical and trabecular bone, as well as in bar deformations, depending on the material, geometry, and surgical technique employed, identifying configurations with superior biomechanical behaviour. The synthesis of these findings provided scientific and technical foundations for the formulation of a protocol aimed at optimizing the predictability, stability, and durability of implant-supported oral rehabilitations in fully edentulous patients of the mandible.