Misfit evaluation of dental implant-supported metal frameworks manufactured with different techniques: Photoelastic and strain gauge measurements

This study aims to compare in-vitro the fitting accuracy of implant-supported metal frameworks used for full-arch orthodontic restoration. The hypotheses tested were as follows: (1) for a fixed implant morphology, strains developed within the framework depend on how the framework had been fabricated and (2) stresses transferred to the implant-bone interface are related to the amount of framework misfit. Metal frameworks were fabricated using four different manufacturing techniques: conventional lost-wax casting, resin cement luting, electrospark erosion, and computer-aided design/computer-aided manufacturing milling. Each framework was instrumented with three strain gauges to measure strains developed because of prosthetic misfit, while quantitative photoelastic analysis was used to assess the effect of misfit at the implant-resin interface. All the tested frameworks presented stress polarization around the fixtures. After screw tightening, significantly greater strains were observed in the lost-wax superstructure, while the lowest strains were observed in the luted framework, demonstrating consistent adaptation and passive fitting. No significant difference in stress distribution and marginal fit was found for bars fabricated by either computer-aided design/computer-aided manufacturing or spark erosion. This study suggested that, in spite of known limitations of in-vitro testing, direct luting of mesostructures and abutments should be the first clinical option for the treatment of complete edentulism, ensuring consistent passive fitting and effective cost-benefit ratio.