Rehabilitation in Cases of Maxillary Lateral Incisor Agenesis Using Zirconia Implant and Abutment: Finite Element Analysis and Systematic Review.

Abstract

The use of narrow-diameter implants has emerged as a strategy to compensate for the reduced bone dimensions of maxillary lateral incisor agenesis (MLIA). This study integrates finite element analysis (FEA) and systematic review (SR) to assess the biomechanical and clinical viability of implant-supported crowns in MLIA scenarios. Three-dimensional FEA were built, comprising a control and an atrophic model representative of an MLIA case. Simulations were performed using implants with varying diameters and materials. The risk of implant and abutment mechanical failure and bone resorption were evaluated. The SR was designed to evaluate the consistency between in silico predictions and clinical outcomes. Reduced implant diameter was associated with an increased risk of implant fracture and bone resorption. All implants and abutments in the simulated models exhibited stress values below the critical threshold for titanium and zirconia failure, indicating a low mechanical failure risk under simulated conditions. Additionally, among the 25 studies included in the SR, 19 reported successful outcomes for implant therapy, but no zirconia implants were identified. Titanium implants with regular diameter combined with hybrid abutments demonstrated favorable biomechanical behavior and seem a reliable option for MLIA rehabilitation, offering both structural integrity and esthetic benefits. The implant-prosthetic rehabilitation of MLIA has demonstrated high reliability and predictability in both esthetic and functional outcomes, especially when performed through a multidisciplinary approach involving orthodontics, periodontics, implantology, and prosthodontists. Long-term studies are still necessary to validate the longevity and performance of zirconia implants in MLIA.