Initial and long‐term crestal bone responses to modern dental implants

Abstract

Successful osseointegration is the result of a controlled foreign body reaction to dental implants. Osseointegrated implants have demonstrated excellent long-term survivability, although they may be subject to limited marginal bone loss. Marginal bone loss during the first few years after implant placement seldom represents disease, but is instead the result of an adaptive bone response to surgical trauma and implant loading. It is not uncommon for implants with early marginal bone loss to enter a long-lasting state of bone stability. Extensive bone resorption after the first year is generally due to an exacerbation of adverse body reactions caused by non-optimal implant components, adverse surgery or prosthodontics and/or compromised patient factors. Disease in the form of peri-implantitis is a late complication that affects some implants with suppuration and rapid loss of crestal bone, and is probably caused by bacterial pathogens and immunological reactions. Unfortunately, the literature is not consistent with respect to the type or magnitude of clinical implant problems, including how they are defined and diagnosed. If the peri-implantitis diagnosis is confined to cases with infection, suppuration and significant bone loss, the frequency of the disease is relatively low, which is in sharp contrast to the frequencies reported with unrealistic definitions of peri-implantitis. We suggest that when modern implants are placed by properly trained individuals, only 1-2% of implants show true peri-implantitis during follow-up periods of 10 years or more. Peri-implantitis must be separated from the initial and self-limiting marginal bone loss.

Bone loss around oral and orthopedic implants: An immunologically based condition

“…[21][22][23][24] Clinical evidence indicates that marginal bone loss around oral implants primarily depends on a complication to treatment due to unsuitable implant designs, poor clinical handling, and patients with different tissue complications 21,25,26 (Figure 2). However, periodontitis around teeth and marginal bone loss around oral implants have, in fact, little in common.…”

How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review

“…Some of these disagreements are related to the inconsistency in the case definition, case selection, and the variability in diagnostic thresholds for disease (Albrektsson, Chrcanovic, Ostman & Sennerby, 2017; Coli, Christiaens, Sennerby & Bruyn, 2017; Derks & Tomasi, 2015). Two recent systematic reviews indicated that homogeneity in peri‐implantitis reporting is still lacking.…”

Risk indicators for marginal bone resorption around implants in function for at least 4 years: A retrospective longitudinal study

“…15 This report is supported by finite element studies showing that excessive occlusal stress can concentrate at the implant marginal bone and cause microfracture within the bone. 19 Therefore, the baseline setting is considered to be important for evaluating marginal bone resorption, and to examine the influence of these various factors, it is required that unified standards that take the normal reaction of peri-implant bone into consideration. 18 Consequently, it is essential to understand how various factors influence bone resorption around implants.…”