Dear Editor,
The oral implantologist's goal is a long term functional and esthetic outcome.1 In planning for this, various data are collected and evaluated. One parameter that has not been seriously considered in the past is the patient's bite force capability (BFC).
Treatment planning centers around function, esthetics, and loading. This is accomplished by implant size selection, implant positioning, and prosthetic design. Jaw bite force is generally 2–3 times greater in the posterior jaws than the anterior. Overloading the supporting bone is a basic caveat. Thus, implant size and position are important to prevent an overload of the supporting bone.2–6 Nonetheless, the patient's BFC is the vector behind this occlusal load. It is important, then, for the clinician to have this value to consider implant size, position, and prosthetic occlusal scheme.2–6
Patient bite force capability ranges from 50 to 300 N. Thus, a patient with a low BFC may not require a large long diameter implant in the anterior jaw, but a large BFC may require a long large diameter implant to resist a greater load: larger diameter, long implants may be necessary to prevent an overload. The wider the implant, the less per square millimeter load there is on the supporting bone.2–6 However, implants placed in the anterior Class I maxilla will be subjected to a lingual off-axial load from the mandibular anterior teeth. There may not be generous site length in this area for a large implant. A smaller diameter implant may be required. The prudent clinician may measure the BFC as a guide to implant length and width. A prophylactic lingual relief may be needed to ensure mitigation from that load.2–6
Implants placed in the posterior jaws can be subjected to extreme functional and parafunctional loads. Thus, larger diameter and longer length implants may be required to resist these loads and BFC may be appropriate for proper planning.2–6 A patient with a low BFC may do well with almost any occlusal scheme, but a greater BFC may require an anterior guided occlusal scheme to protect posterior implants from an off-axial load.2–6
A tooth size may present a lever to the opposing dentition. The force on such a lever may impart a magnified load on the supporting bone, thus the clinician should take BFC into account during planning.2–6
Of all the diagnostic parameters, the most important datum may be the BFC. This value influences all the other parameters to a minor or major extent. It may be the primary consideration for a long-term function and esthetic outcome.2–6
