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Clinical implant dentistry and related research
Apr, 2021;23 (2): 159-169.

On marginal bone level changes around dental implants.

Pierluigi Coli, Torsten Jemt
Author Information
  1. Pierluigi Coli: Edinburgh Dental Specialists, Edinburgh, UK. ORCID
  2. Torsten Jemt: Department of Prosthetic Dentistry/Dental Material Science, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden. ORCID
PMID: 33463007 DOI: 10.1111/cid.12970

Abstract

BACKGROUND: Peri-implant bone level values have been used as the clinical standard of reference to describe the status of a dental implant, despite the fact that their significance for the long-term survival of the implant has never been properly assessed.
PURPOSE: To challenge the assumption that the natural course of peri-implant bone loss is the loss of the implant.
MATERIALS AND METHODS: This article is a narrative review on reasons and interpretations of marginal bone level changes around dental implants.
RESULTS AND CONCLUSIONS: Different views regarding the pattern and progression of marginal bone loss depending on dental specialties have been identified. However, the present finding of a negative correlation between an increasing cumulative marginal bone loss and a decreasing risk of implant failures over time indicates that peri-implant marginal bone loss does not necessarily represent a condition of disease. Reduction of marginal bone levels may be observed in a majority of patients during follow-up time, with only a minority of those patients losing implants and implant-supported prostheses in the long term. Bone level changes seem often to occur as a consequence of physiological processes and/or as an adaptation to altered external as well as host response factors. Periodical radiological assessments of implant-restorations remain a valid diagnostic tool for the detection of potential implant fractures, loss of osseointegration, screws working loose and for the detection of the few cases with advanced, continuously progressing marginal bone loss during time. The detection of peri-implant marginal bone loss at one time point should not be immediately considered as a sign of ongoing pathology and of an increased risk of future loss of the implant in question.

Keywords

bone loss cumulative survival rate implant failure marginal bone level oral implants

References

The Toronto Osseointegration Conference Revisited: The Toronto Osseointegration Conference Revisited: An interview with Dr. Asbjorn Jokstad. Osseointegration 2008;7-9.
Brånemark PI, Hansson BO, Adell R, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl. 1977;16:1-132.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10(6):387-416.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11-25.
Faggion CM, Listl S, Tu YK. Assessment of endpoints in studies on peri-implantitis treatment: a systematic review. J Dent. 2010;38:443-450.
Fleming TR, DeMets DL. Surrogate end points in clinical trials: are we being misled? Ann Intern Med. 1996;125:605-613.
Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring T, eds. Proceedings of the First European Workshop on Periodontology. London: Quintessence Publishing; 1994:365-369.
Lindhe J, Meyle J, Group D of European Workshop on Periodontology. Peri-implant diseases: consensus report of the sixth European workshop on periodontology. J Clin Periodontol. 2008;35(8 Suppl):282-285.
Lang NP, Berglundh T, Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now? consensus of the seventh European workshop on periodontology. J Clin Periodontol. 2011;38(Suppl 11):178-181.
Sanz M, Chapple IL, Working Group 4 of the VIII European Workshop on Periodontology. Clinical research on peri-implant diseases: consensus report of Working Group 4. J Clin Periodontol. 2012;39(Suppl 12):202-206.
Jepsen S, Berglundh T, Genco R, et al. Primary prevention of peri-implantitis: managing peri-implant mucositis. J Clin Periodontol. 2015;42(Suppl 16):S152-S157.
Tomasi C, Derks J. Clinical research of peri-implant diseases: quality of reporting, case definition and methods to study incidence, prevalence and risk factors for periimplant diseases. J Clin Periodontol. 2012;12:207-223.
Jemt T, Albrektsson T. Do long-term followed-up Branemark implants commonly show evidence of pathological bone breakdown? A review based on recently published data. Periodontol 2000. 2008;47:133-142.
Koldsland OC, Scheie AA, Aass AM. Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Periodontol. 2010;81(2):231-238.
Caton JG, 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 Clin Periodontol. 2018;45(Suppl 20):S1-S8.
Coli P, Christiaens V, Sennerby L, Bruyn H. Reliability of periodontal diagnostic tools for monitoring peri-implant health and disease. Periodontol 2000. 2017;73(1):203-217.
Coli P, Sennerby L. Is peri-implant probing causing over-diagnosis and over-treatment of dental implants? J Clin Med. 2019;8(8):1123.
Verhoeven JW, Cune MS, de Putter C. Reliability of some clinical parameters of evaluation in implant dentistry. J Oral Rehabil. 2000;27:211-216.
Jemt T, Eriksson J. Implant failures before and after peri-implantitis surgery. A retrospective study on 207 consecutively treated patients. Clin Implant Dent Relat Res. 2020;22(5):567-573. https://doi.org/10.1111/cid.12931.
Jemt T, Sundén Pikner S, Gröndahl K. Changes of marginal bone level in patients with progressive bone loss at Brånemark system implants: a radiographic follow-up study over an average of 9 years. Clin Implant Dent Relat Res. 2015;17:619-628.
Jacobs R, Esposito M. Editorial: On peri-implant bone level measures: to see or not to see, that is the question. Eur J Oral Implantol. 2016;9(Suppl 1(2)):119-121.
Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects with progressive bone loss at implants. Clin Oral Implants Res. 2005;16(4):440-446.
Fransson C, Wennström J, Berglundh T. Clinical characteristics at implants with a history of progressive bone loss. Clin Oral Implants Res. 2008;19(2):142-147.
Pikner SS, Gröndahl K. Radiographic analyses of "advanced" marginal bone loss around Brånemark dental implants. Clin Implant Dent Relat Res. 2009;11(2):120-133.
Fransson C, Tomasi C, Pikner SS, et al. Severity and pattern of peri-implantitis-associated bone loss. J Clin Periodontol. 2010;37(5):442-448.
Jemt T. Data on implant failures will show different results depending on how patients are compiled and analyzed: a retrospective study on 3902 individual patients treated either with one single implant or implants in the edentulous upper jaw. Clin Implant Dent Relat Res. 2020;22:226-236. https://doi.org/10.1111/cid.12886.
Engfors I, Örtorp A, Jemt T. Fixed implant-supported prostheses in elderly patients. A 5-year retrospective study of 133 edentulous patients older than 79 years. Clin Implant Dent Relat Res. 2004;6:190-198.
Örtorp A, Jemt T. Clinical experience of computer controlled-milled titanium frameworks supported by implants in the edentulous jaw: a 5-year prospective study. Clin Implant Dent Relat Res. 2004;6:199-209.
Jemt T, Johansson J. Implant treatment in the edentulous maxillae: a 15-year follow-up study on 76 consecutive patients provided with fixed prostheses. Clin Implant Dent Relat Res. 2006;8:61-69.
Friberg B, Jemt T. Turned Brånemark system implants in wide and narrow edentulous maxillae: a retrospective clinical study. Clin Implant Dent Relat Res. 2008;10:78-85.
Örtorp A, Jemt T. Laser-welded implant titanium frameworks in the partially edentulous mandible: a 10-year comparative follow-up study. Clin Implant Dent Relat Res. 2008;10:128-139.
Jemt T. Single implants in the anterior maxilla after 15-years of follow-up. A comparison with mesial implants in the edentulous maxilla. Int J Prosthodont. 2008;21:400-408.
Jemt T. Cemented CeraOne and porcelain fused to TiAdapt abutment single implant crown restorations: a 10-year comparative follow-up study. Clin Implant Dent Relat Res. 2009;11:303-310.
Örtorp A, Jemt T. Early laser-welded titanium frameworks supported by implants in the edentulous mandible: a 15-year comparative follow-up study. Clin Implant Dent Relat Res. 2009;11:311-322.
Hjalmarsson L, Smedberg J-I, Pettersson M, Jemt T. Implant level Cresco-prostheses in the edentulous upper jaw. A comparison with conventional abutment level prostheses after 5 years in function. Int J Prosthodont. 2011;24:158-167.
Kowar J, Eriksson A, Jemt T. Fixed implant-supported prostheses in elderly patients: a 5-year retrospective comparison between partially and completely edentulous patients of an age of 80 years or older at implant surgery. Clin Implant Dent Relat Res. 2013;15:37-46.
Jemt T, Stenport V, Friberg B. Implant treatment with fixed prostheses in the edentulous maxilla. Part 1: implants and biological response in two patient cohorts restored 1986-1987 and 15 years later. Int J Prosthodont. 2011;24:345-355.
Jemt T. Implant failures and age at the time of surgery: a retrospective study on implant treatments in 4585 edentulous jaws. Clin Implant Dent Relat Res. 2019;21(4):514-520.
Jemt T. Implant failures and age at the time of surgery: a retrospective study on implant treatment in 2915 partially edentulous jaws. Clin Implant Dent Relat Res. 2019;21(4):686-692.
Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. A retrospective study on clinical and radiological outcomes of oral implants in patients followed up for a minimum of 20 years. Clin Implant Dent Relat Res. 2018;20(2):199-207.
Albrektsson T, Buser D, Sennerby L. Crestal bone loss and oral implants. Clin Implant Dent Relat Res. 2012;14(6):783-791.
Schou S, Holmstrup P, Worthington HV, Esposito M. Outcome of implant therapy in patients with previous tooth loss due to periodontitis. Clin Oral Implants Res. 2006;17(Suppl 2):104-123.
Hugoson A, Laurell L. A prospective longitudinal study on periodontal bone height changes in a Swedish population. J Clin Periodontol. 2000;27(9):665-674.
Carlsson GE, Bergman B, Hedegård B. Changes in contour of the maxillary alveolar process under immediate dentures. A longitudinal clinical and x-ray cephalometric study covering 5 years. Acta Odontol Scand. 1967;25(1):45-75.
Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent. 1972;27(2):120-132.
Bryant RT. Oral implant outcomes predicted by age- and site specific aspects of bone conditions. PhD Thesis 2001. Toronto: Department of Prosthodontics, University of Toronto.
Jemt T. On implant prosthodontics: one narrative, twelve voices-4. Int J Prosthodont. 2018;31(Suppl):s31-s34.
Oh TJ, Yoon J, Misch CE, Wang HL. The causes of early implant bone loss: myth or science? J Periodontol. 2002;73(3):322-333.
Qian J, Wennerberg A, Albrektsson T. Reasons for marginal bone loss around oral implants. Clin Implant Dent Relat Res. 2012;14(6):792-807.
Koka S, Zarb G. On osseointegration: the healing adaptation principle in the context of osseosufficiency, osseoseparation, and dental implant failure. Int J Prosthodont. 2012;25(1):48-52.
Anderson JM. Inflammation wound healing, and the foreign-body response. Biomaterials Science: An Introduction to Materials. 3rd ed. Cambridge, UK: Academic Press; 2013:503-512.
Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. Semin Immunol. 2008;20:86-100.
Miron RJ, Zohdi H, Fujioka-Kobayashi M, Bosshardt DD. Giant cells around bone biomaterials: osteoclasts or multi-nucleated giant cells? Acta Biomater. 2016;46:15-28.
Naveau A, Shinmyouzu K, Moore C, Avivi-Arber L, Jokerst J, Koka S. Etiology and measurement of peri-implant Crestal bone loss (CBL). J Clin Med. 2019;1:8(2).
Trindade R, Albrektsson T, Galli S, Prgomet Z, Tengvall P, Wennerberg A. Osseointegration and foreign body reaction: titanium implants activate the immune system and suppress bone resorption during the first 4 weeks after implantation. Clin Implant Dent Relat Res. 2018;20:82-91.
Trindade R, Albrektsson T, Galli S, Prgomet Z, Tengvall P, Wennerberg A. Bone immune response to materials, part I: titanium, peek and copper in comparison to sham at 10 days in rabbit tibia. J Clin Med. 2018;7(12):526.
Donath K. Pathogenesis of bony pocket formation around dental implants. J Dent Assoc S Afr. 1992;47:204-208.
Donath K, Laass M, Günzl HJ. The histopathology of different foreign body reactions in oral soft tissue and bone tissue. Virchows Archiv A Pathol Anat Histopatol. 1992;420:131-137.
Trindade R, Albrektsson T, Tengvall P, Wennerberg A. Foreign body reaction to biomaterials: on mechanisms for buildup and breakdown of osseointegration. Clin Implants Dent Relat Res. 2016;18:192-203.
Albrektsson T, Chrcanovic B, Jacobsson M, Wennerberg A. Osseointegration of implants: a biological and clinical overview. JSM Dent Surg. 2017;2:1022-1027.
Albrektsson T, Jemt T, Mölne J, Tengvall P, Wennerberg A. On inflammation-immunological balance theory: a critical apprehension of disease concepts around implants-mucositis and marginal bone loss may represent normal conditions and not necessarily a state of disease. Clin Implant Dent Relat Res. 2019;21(1):183-189.
Takayanagi H. Osteoimmunology: shared mechanisms and crosstalk between the immune and bone systems. Nat Rev Immunol. 2007;7:292-304.
Takayanagi H. New developments in osteoimmunology. Nat Rev Rheumatol. 2012;8(11):684-689.
Albrektsson T, Dahlin C, Reinedahl D, Tengvall P, Trindade R, Wennerberg A. An imbalance of the immune system instead of a disease behind marginal bone loss around oral implants: position paper. Int J Oral Maxillofac Implants. 2020;35(3):495-502.
Malmqvist JP, Sennerby L. Clinical report on the success of 47 consecutively placed Core-vent implants followed from 3 months to 4 years. Int J Oral Maxillofac Implants. 1990;5(1):53-60.
Watson CJ, Tinsley D, Ogden AR, Russell JL, Mulay S, Davison EM. A 3 to 4 year study of single tooth hydroxylapatite coated endosseous dental implants. Br Dent J. 1999;187(2):90-94.
Mau J, Behneke A, Behneke N, et al. Randomized multicenter comparison of two coatings of intramobile cylinder implants in 313 partially edentulous mandibles followed up for 5 years. Clin Oral Implants Res. 2002;13(5):477-487.
Sennerby L, Rocci A, Becker W, Jonsson L, Johansson LA, Albrektsson T. Short-term clinical results of Nobel direct implants: a retrospective multicentre analysis. Clin Oral Implants Res. 2008;19(3):219-226.
Friberg B, Jemt T. Rehabilitation of edentulous mandibles by means of osseointegrated implants: a 5-year follow-up study on one or two-stage surgery, number of implants, implant surfaces, and age at surgery. Clin Implant Dent Relat Res. 2015;17(3):413-424.
Hall J, Britse AO, Jemt T, Friberg B. A controlled clinical exploratory study on genetic markers for peri-implantitis. Eur J Oral Implantol. 2011;4:371-382.
Pamidronate MR, Ruggiero S, Mehrotra B, Rosenberg T, Engroff S. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005;2005:99-102.
Madrid C, Sanz M. What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009;20:87-95.
Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res. 1996;7:329-336.
Albrektsson T. Is surgical skill more important for clinical success than changes in implant hardware? Clin Implant Dent Relat Res. 2001;3:174-175.
Jemt T. Implant survival in the posterior partially edentulous Arch-30 years of experience. Part IV: a retro-prospective multivariable regression analysis on implant failures related to arch and implant surface. Int J Prosthodont. 2019;32(2):143-152.
Jemt T. Implant survival in the partially edentulous jaw: 30 years of experience. Part III: a retro-prospective multivariate regression analysis on overall implant failures in 2,915 consecutively treated arches. Int J Prosthodont. 2019;32(1):36-44.
Canullo L, Tallarico M, Radovanovic S, Delibasic B, Covani U, Rakic M. Distinguishing predictive profiles for patient-based risk assessment and diagnostics of plaque induced, surgically and prosthetically triggered peri-implantitis. Clin Oral Implants Res. 2016;27:1243-1250.
Chen ST, Darby IB, Reynolds EC. A prospective clinical study of non-submerged immediate implants: clinical outcomes and esthetic results. Clin Oral Implants Res. 2007;18:552-562.
Linkevicius T, Puisys A, Vindasjute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013;24:1179-1184.
Albrektsson T, Canullo L, Cochran D. DeBruyn H “Peri-implantitis”: a complication of a foreign body or a man-made “disease.” Facts and fiction. Clin Implant Dent Relat Res. 2016;18:840-849.
Albrektsson T, Becker W, Coli P, Jemt T, Mölne J, Sennerby L. Bone loss around oral and orthopedic implants: an immunologically based condition. Clin Implant Dent Relat Res. 2019;21(4):786-795.
Coli P, Jemt T. Are marginal bone level changes around dental implants due to infection? Clin Implant Dent Relat Res. 2020;1-8. https://doi.org/10.1111/cid.12971

MeSH Term

Alveolar Bone Loss
Dental Implantation, Endosseous
Dental Implants
Dental Prosthesis Design
Dental Prosthesis, Implant-Supported
Dental Restoration Failure
Follow-Up Studies
Humans
Osseointegration

Chemicals

Dental Implants
Journal Article Review

Word Cloud

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