Peri-implant bone mechanobiology. Review of the literature

Abstract

The mechanical load applied during bone regeneration in implant treatments influences the early formation of peri-implant bone tissue through the activation of different pathways. The aim of this review was to determine the currently available scientific evidence in this field. Results: There is scientific evidence that the immediate application of an axial load in implantology stimulates bone formation, as measured by various histomorphometric parameters. Different physiological mechanisms (e.g., production of nitric o�ide, prostaglandin �2) participate in this effect, although their action has not been fully elucidated.Conclusion: The precise role of mechanical loading in the osseointegration process remains unknown. Further studies are required to demonstrate the biological mechanisms involved and the load range producing the most effective response and to develop devices for obtaining predictable clinical outcomes.

Immediate Implants with Early Loading Accompanying Autogenous Bone Grafting in a Maxilla with Periodontal Destruction: A Case Report

“…Leucht et al reported that an enhanced osteoblastic differentiation was observed in the early loaded group in the peri-implant tissue [14]. Implantation surgery, as well as the presence of prosthetic loading, might alter the mechanobiology of the peri-implant bone, causing a different reaction to the loading than the bone without an implant [10,15].…”

Bone remodeling and mechanobiology around implants: Insights from small animal imaging

“…There is evidence that aging and estrogen removal cause dysregulation in the mechanical control of bone (re)modeling, resulting in decreased sensitivity to mechanical stimulation . There are also concerns that implantation surgery as well as the presence of the implant may alter the mechanobiology of peri‐implant bone, causing a different response to mechanical loading than bone without an implant …”

“…18,19 There are also concerns that implantation surgery as well as the presence of the implant may alter the mechanobiology of peri-implant bone, causing a different response to mechanical loading than bone without an implant. 25 This section summarizes recent efforts to understand peri-implant bone behavior following in vivo controlled mechanical stimulation in small animal models ( Table 2). Three different modalities to administer mechanical loading are considered: (i) loading applied directly to the implant (Fig.…”

“…Those studies have highlighted the potential of mechanical stimulation to promote early implant osteogenesis . However, there are still clinically relevant concerns related to earliest time, magnitude and frequency of the applied stimulation . Moreover, implantation is often performed in aged or osteoporotic bones, which seem to have a reduced “mechano‐responsiveness,” thus suggesting that higher mechanical stimulation may be required to produce a relevant anabolic response.…”

“…17 However, there are still clinically relevant concerns related to earliest time, magnitude and frequency of the applied stimulation. [25][26][27][28] Moreover, implantation is often performed in aged or osteoporotic bones, which seem to have a reduced "mechanoresponsiveness," 18,29 thus suggesting that higher mechanical stimulation may be required to produce a relevant anabolic response. Nevertheless, high loads can cause the formation of weak fibrous tissues rather than bone, at the bone-implant interface.…”