Journal of Prosthetic Dentistry
Clinical Report|Articles in Press

Rehabilitation of a patient with mandibular flexure using contemporary glass-infiltrated high performance CAD-CAM polymers: A clinical report with 1-year follow-up

  • Francisco X. Azpiazu-Flores
    Corresponding author: Dr Francisco X. Azpiazu-Flores, Department of Restorative Dentistry, University of Manitoba, 790 Bannatyne Ave, Winnipeg, Manitoba, CANADA
    Former Graduate student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio

    Assistant Professor, Department of Restorative Dentistry, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
    Search for articles by this author
  • Damian J. Lee
    Associate Professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio

    Director of the Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
    Search for articles by this author
  • Severino J. Mata-Mata
    Former Graduate student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio

    Private Practitioner and Assistant Professor, Facultad de Odontologia, Universidad Francisco Marroquin, Ciudad de Guatemala, Guatemala
    Search for articles by this author
  • Fengyuan Zheng
    Clinical Associate Professor, Department of Restorative Sciences, Division of Prosthodontics, University of Minnesota School of Dentistry, Minneapolis, Minn
    Search for articles by this author
Published:February 22, 2023DOI:


      Mandibular flexure is a phenomenon generated by the action of the muscles of mastication and other muscles in the head and neck region which can lead to prosthetic and biological complications such as pain, material fracture, and bone loss around dental implants. To avoid such complications, dividing the mandibular prostheses into 3 short-span prostheses or sectioning at the midline has been suggested. This clinical report presents the management of an edentulous patient with clinically detectable mandibular flexure treated with a 1-piece metal-free complete arch implant-supported prosthesis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Werbelow L.
        • Weiss M.
        • Schramm A.
        Long-term follow-up of full-arch immediate implant-supported restorations in edentulous jaws: a clinical study.
        Int J Implant Dent. 2020; 6: 34
        • Maló P.
        • de Araújo Nobre M.
        • Moura Guedes C.
        • et al.
        Short-term report of an ongoing prospective cohort study evaluating the outcome of full-arch implant-supported fixed hybrid polyetheretherketone-acrylic resin prostheses and the All-on-Four concept.
        Clin Implant Dent Relat Res. 2018; 20: 692-702
        • Adell R.
        • Lekholm U.
        • Rockler B.
        • Brånemark P.I.
        A 15-year study of osseointegrated implants in the treatment of the edentulous jaw.
        Int J Oral Surg. 1981; 10: 387-416
        • Del Fabbro M.
        • Ceresoli V.
        The fate of marginal bone around axial vs. tilted implants: a systematic review.
        Eur J Oral Implantol. 2014; 7 Suppl 2: S171-S189
        • Haraldson T.
        • Carlsson G.E.
        Bite force and oral function in patients with osseointegrated oral implants.
        Scand J Dent Res. 1977; 85: 200-208
        • Maló P.
        • Rangert B.
        • Nobre M.
        “All-on-Four” immediate-function concept with Brånemark System® implants for completely edentulous mandibles: a retrospective clinical study.
        Clin Implant Dent Relat Res. 2003; 5 Suppl 1: 2-9
        • Piscopo M.
        • Grande F.
        • Catapano S.
        Full digital workflow for prosthetic full-arch immediate loading rehabilitation using OT-bridge system: a case report.
        Prosthesis. 2022; 4: 213-223
        • Passaretti A.
        • Petroni G.
        • Miracolo G.
        • Savoia V.
        • Perpetuini A.
        • Cicconetti A.
        Metal free, full arch, fixed prosthesis for edentulous mandible rehabilitation on four implants.
        J Prosthodont Res. 2018; 62: 264-267
        • Cabanes Gumbau G.
        • Canet Lopez A.
        • Peñarrocha Diago M.
        • Peñarrocha Diago M.
        All-on-4 with tapered neck implants and a hybrid prosthesis with a fiber glass reinforced structure.
        J Oral Rehabil. 2019; 5: 16-23
        • Branemark P.I.
        Osseointegration and its experimental background.
        J Prosthet Dent. 1983; 50: 399-410
        • Bidra A.S.
        • Tischler M.
        • Patch C.
        Survival of 2039 complete arch fixed implant-supported zirconia prostheses: a retrospective study.
        J Prosthet Dent. 2018; 119: 220-224
        • Sivaraman K.
        • Chopra A.
        • Venkatesh S.B.
        Clinical importance of median mandibular flexure in oral rehabilitation: a review.
        J Oral Rehabil. 2016; 43: 215-225
        • Law C.
        • Bennani V.
        • Lyons K.
        • Swain M.
        Mandibular flexure and its significance on implant fixed prostheses: a review.
        J Prosthodont. 2012; 21: 219-224
        • Gao J.
        • Li X.
        • He J.
        • Jiang L.
        • Zhao B.
        The effect of mandibular flexure on the design of implant-supported fixed restorations of different facial types under two loading conditions by three-dimensional finite element analysis.
        Front Bioeng Biotechnol. 2022; 10: 928656
        • Krishnakumar S.
        • Senthilvelan T.
        Polymer composites in dentistry and orthopedic applications-a review.
        Mater Today. 2021; 46: 9707-9713
        • Pera F.
        • Pesce P.
        • Solimano F.
        • Tealdo T.
        • Pera P.
        • Menini M.
        Carbon fibre versus metal framework in full-arch immediate loading rehabilitations of the maxilla - a cohort clinical study.
        J Oral Rehabil. 2017; 44: 392-397
        • Skalak R.
        Biomechanical considerations in osseointegrated prostheses.
        J Prosthet Dent. 1983; 49: 843-848
        • Erkmen E.
        • Meriç G.
        • Kurt A.
        • Tunç Y.
        • Eser A.
        Biomechanical comparison of implant retained fixed partial dentures with fiber reinforced composite versus conventional metal frameworks: a 3D FEA study.
        J Mech Behav Biomed Mater. 2011; 4: 107-116
        • Mendes de Oliveira R.M.
        • Emtiaz S.
        Mandibular flexure and dental implants: a case report.
        Implant Dent. 2000; 9: 90-95
        • Fischman B.
        The influence of fixed splints on mandibular flexure.
        J Prosthet Dent. 1976; 35: 643-647
        • Fischman B.
        The rotational aspect of mandibular flexure.
        J Prosthet Dent. 1999; 4: 483-485
        • Omar R.
        • Wise M.D.
        Mandibular flexure associated with muscle force applied in the retruded axis position.
        J Oral Rehabil. 1981; 8: 209-221
        • Alvarez-Arenal A.
        • Lasheras F.S.
        • Fernández E.M.
        • González I.
        A jaw model for the study of the mandibular flexure taking into account the anisotropy of the bone.
        Math Comput Model. 2009; 50: 695-704
        • Martin-Fernandez E.
        • Gonzalez-Gonzalez I.
        • deLlanos-Lanchares H.
        • Mauvezin-Quevedo M.A.
        • Brizuela-Velasco A.
        • Alvarez-Arenal A.
        Mandibular flexure and peri-implant bone stress distribution on an implant-supported fixed full-arch mandibular prosthesis: 3D finite element analysis.
        Biomed Res Int. 2018; 2018: 8241313
        • Paez C.Y.
        • Barco T.
        • Roushdy S.
        • Andres C.
        Split-frame implant prosthesis designed to compensate for mandibular flexure: a clinical report.
        J Prosthet Dent. 2003; 89: 341-343
        • Alvarez-Arenal A.
        • Brizuela-Velasco A.
        • deLlanos-Lanchares H.
        • Gonzalez-Gonzalez I.
        Should oral implants be splinted in a mandibular implant-supported fixed complete denture? A 3-dimensional-model finite element analysis.
        J Prosthet Dent. 2014; 112: 508-514
        • Caton J.G.
        • Armitage G.
        • Berglundh T.
        • et al.
        A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification.
        J Periodontol. 2018; 89: S1-S8
        • Smith D.E.
        Interim dentures and treatment dentures.
        Dent Clin North Am. 1984; 28: 253-271
        • Butura C.C.
        • Galindo D.F.
        • Cottam J.
        • Adams M.
        • Jensen O.
        Hourglass mandibular anatomic variant incidence and treatment considerations for all-on-four implant therapy: report of 10 cases.
        J Oral Maxillofac Surg. 2011; 69: 2135-2143
        • Jensen O.T.
        • Adams M.W.
        • Cottam J.R.
        • Parel S.M.
        • Phillips W.R.
        The all on 4 shelf: mandible.
        J Oral Maxillofac Surg. 2011; 69: 175-181
        • Blasi A.
        • Henarejos-Domingo V.
        • Madeira S.
        • Blasi G.
        • Roig M.
        Stone verification device for verifying the definitive cast of an implant-supported restoration: a dental technique.
        J Prosthet Dent. 2022; 128: 858-863
        • Figueras-Alvarez O.
        • Cantó-Navés O.
        • Real-Voltas F.
        • Roig M.
        Protocol for the clinical assessment of passive fit for multiple implant-supported prostheses: a dental technique.
        J Prosthet Dent. 2021; 126: 727-730
        • Azpiazu-Flores F.X.
        • Mata-Mata S.J.
        • Lee D.J.
        Detection of mandibular flexure with a dental plaster verification device: a clinical report with video recording.
        J Prosthet Dent. 21 April 2022; ([Epub ahead of print])