Occlusal Overload Research Articles

PRINCIPAIS CAUSAS DA PERDA PRECOCE DOS IMPLANTES DENTÁRIOS OSSEOINTEGRADOS

Osseointegration, crucial for implant success, can be compromised by biological, mechanical, and systemic factors. The study aimed to investigate the main causes of early failure of osseointegrated dental implants, which, despite advances in implantology, still present a clinical challenge. The methodology consisted of a comprehensive literature review, using articles published between 2014 and 2024, from databases such as Scielo and Google Scholar. Relevant studies were selected using the descriptors “dental implant,” “subperiosteal implant,” and “osseointegration,” addressing causes such as peri-implantitis, insufficient bone quality, and technical failures during installation. The results indicate that early implant failure is associated with inflammatory complications, such as peri-implantitis and peri-implant mucositis, as well as factors like low bone density, inadequate immune response, and occlusal overload. Systemic conditions, such as diabetes and smoking, were also highlighted as significant risk factors for implant failure. Correct technical execution, combined with proper planning, proved to be essential in minimizing failures and ensuring long-term success.

Cluster behavior in dental implant failure - A scoping review.

To provide an overview of cluster behavior in dental implant failure including the reported prevalence in modern roughened surface implants as well as the risk factors associated with cluster failures. An electronic search for articles in the English language literature published from January 1, 2000, to March 8, 2023, was performed using PubMed, Embase, Dentistry and Oral Sciences, ProQuest, and Central search engines. Using a standardized systematic search process and predetermined inclusion and exclusion criteria in three stages, the final list of selected articles reporting on cluster behavior in dental implant failure was obtained. Cluster behavior was defined as the failure of two or more implants in the same patient within a 2-year period irrespective of the site. Data from the selected articles were reviewed, critically analyzed, interpreted, and reported. The initial electronic search resulted in 948 titles. After applying inclusion and exclusion criteria, the systematic search process resulted in five clinical studies reporting data on cluster behavior of dental implant failure with modern roughened surfaces. These five studies reported on a total of 9986 implants with 858 reported failures (early and late) over varying periods. Out of the 858 implant failures, 217 implants (25.2%) exhibited cluster behavior. The overall prevalence of cluster behavior of modern roughened surface implant failure was 2.1%. The most common location risk factors reported were posterior maxilla, history of previous implant failures, poor bone quality, and occlusal overload. Cluster behavior occurs in 25% of modern roughened surface implant failures which is significantly less than machined surface cluster implant failures. Nevertheless, the overall prevalence of cluster pattern of implant failure of modern roughened surface implants is reasonably low at 2%.

Etiology of gingival recession - a literature review.

Gum recession is a common problem that in most cases does not cause any bothersome symptoms to the patient. They can affect people of any age and are most often diagnosed on the vestibular surfaces of the teeth. They are manifested by the exposure of part of the root through the apical migration of the gingival margin. Its etiology is not fully understood, but it is known that it consists of many factors. The authors discussed such factors as inflammation, gum biotype, patient's age, mechanical and chemical damage, smoking, presence of tartar, cervical defects and their reconstruction, orthodontic treatment, occlusal overload and iatrogenic factors. Additionally, important risk factors also include genetic predispositions and abnormalities in the immune system. In addition, certain hygiene habits, such as improper brushing techniques or lack of regular check-ups at the dentist, may also contribute to the development of gum recession. Understanding the comprehensive nature of these factors is crucial to the effective treatment and prevention of this common condition. It is also worth taking into account the importance of educating patients on proper oral hygiene and regular dental check-ups to prevent gum recession.

The Successful Treatment of Peri-implantitis with Guided Bone Regeneration with an 8-Year Follow-up: Case Report and Literature Analysis

Replacement of missing teeth or unrestorable ones with dental implant-supported restorations is a substantial part of the clinical treatment protocol. However, with the increase in dental implants being placed worldwide, complications with this treatment have also risen in numbers. Complications may result from poor selection of cases with inappropriate treatment planning, occlusal overloading, or with poor follow-up care. The most common complications are the ones related to the presence of inflammation and include perimucositis and peri-impantitis. Peri-implantitis is an inflammatory condition that affects the soft and hard tissues around osseointegrated implants and results in the establishment of a peri-implant pocket and the loss of supporting bone. Nonsurgical therapy, the use of locally and systemically given antibiotics, and surgical regimens intended to replace the lost bone and soft tissue around the implants are among the documented treatment options. The aim of this article is to present a case report on the successful management of a case of peri-implantitis with nonsurgical and surgical approach following the ITI treatment protocol with a 5-year follow-up, along with a review of some of the treatment options used in their management.

Gonial angle and late implant loss: A retrospective clinical study.

Occlusal overload can cause late implant loss. However, whether the magnitude of the occlusal force is a risk factor for late implant loss remains unclear. Thus, this clinical study aimed to determine the relationship between the gonial angle (GoA), which is associated with the magnitude of occlusal force, and late implant loss. All implants with fixed prostheses placed at the Niigata University Hospital between April 2006 and August 2019 were included in this retrospective study. The implants with and without late loss were compared. Relevant variables, including smoking habits, diabetes mellitus status, remaining dentition, implant length and diameter, prosthesis design, retention systems, splinting, and GoA were assessed. Log-rank test and Cox proportional hazards regression analysis were used to estimate the adjusted hazard ratio (aHR) and to calculate the corresponding 95% confidence intervals (CI) for late implant loss. A total of 919 patients (349 men and 570 women) with 2512 implants were included in this study. Cox proportional hazards regression analysis revealed that a 10° decrease in the GoA (aHR, 1.588; 95% CI, 1.115-1.766; P = 0.010), smoking habits (aHR, 3.909; 95% CI, 2.131-7.168; P < 0.001), and male sex (aHR, 2.584; 95% CI, 1.376-4.850; P = 0.003) were significantly associated with late implant loss. Within the limitations of this retrospective study of 2512 implants, smaller GoA, smoking habits, and male sex were risk factors for late implant loss.

Histological Perspectives on Dental Implant Failure: A Case Report and Analysis of Peri-Implant Bone Histology

Peri-implant bone histology plays a crucial role in understanding the mechanisms underlying implant failure. This article presents a case report of a failed dental implant in a 72-year-old male patient, with a focus on the histological evaluation of the peri-implant bone. The patient underwent an All-in-4 implant-based denture treatment plan, which initially showed promising results but later resulted in implant failure. A trephine core biopsy was performed to assess the histology of the failed implant site and determine the cause of failure at the microscopic level. Histological analysis revealed the presence of graft material acting as a scaffold, surrounded by dense fibrosis and chronic inflammatory infiltrate. These findings indicate a failure of osseointegration and suggest possible causes for implant failure, such as inadequate tissue integration and host response. Factors contributing to implant failure, including occlusal overload, peri-implantitis, and systemic conditions, were discussed in the context of the case. Understanding the histological changes associated with implant failure is crucial for improving treatment outcomes and developing preventive strategies. Preoperative assessment, including evaluation of bone density and identification of systemic risk factors, is essential for successful implant placement. Retrieval and histological analysis of failed implants provide valuable insights into tissue responses and areas for improvement in implant design and surgical techniques. This case report highlights the significance of peri-implant bone histology in diagnosing and managing implant failure, with implications for enhancing implant success rates and patient care in implant dentistry. Further research in this field will contribute to advancements in implantology and the development of evidence-based protocols for implant treatment.

Implant Supported Fixed Prostheses and Bruxism: An Overview

The bruxism is an oral parafunction characterized by occlusal overload contacts. The global management of bruxism patients may require a prosthetic rehabilitation whether it is fixed, removable or more recently implant-supported prostheses. The aim of our literature review is to evaluate the survival rate of implant-supported prostheses in patients with bruxism, to detail the different types of complications, and to develop recommendations to ensure the longevity of this type of prosthesis in this type of patient.

Masseter muscle cross-sectional area and late implant failure: A case-control study.

Occlusal overload is considered to be one of the causes of late implant failure. However, it is unclear whether the magnitude of the patient's occlusal force is a risk factor for late implant failure. This case-control study aimed to clarify the association between the cross-sectional area (CSA) of the masseter muscle and late implant failure. This case-control study was limited to implant-supported fixed prostheses. We compared cases with at least one late implant failure (n=25 patients) to controls (n=82 patients) without implant failure. Patients were matched by age, sex, year of surgery, jaw and tooth type, and bone graft. Log-rank and Cox proportional hazard regression analyses were used to identify possible risk factors for late implant failure. The incidence of late implant failure was significantly associated with masseter muscle CSA ≥504.5 mm2 (hazard ratio: 4.43; 95% CI: 1.82-10.79; p < 0.01). Higher masseter muscle CSA increases the risk of late implant failure.

Causes, risk factors and complications of dental implant failure

Osseointegration, which refers to the direct attachment of dental implants (DIs) to the neighboring host bone, is a great predictor of the therapeutic efficacy of DIs. The factors that determine whether DIs are successful have been evolving over time. Presently, these factors comprise the lack of mobility at the beginning of the prosthetic stage. DIs have a high chance of success; however, they occasionally fail. The failure of properly implanted DIs has been attributed to inappropriate patient identification; inadequate dental hygiene associated with microbial plaque buildup. The three most significant factors that lead to early implant failure appear to be a paucity of basic stability, surgical injury, and infection. Due to disruption of the basic bone recovery process, initial symptoms of infection may portend a far more serious outcome than if similar issues arise later. It appears that peri-implantitis and occlusal overloading are the main causes of late failure. Among the predisposing variables for implant problems and failure include poor prosthesis fabrication and subpar implant design.

Evaluation of two different occlusal patterns on single posterior implant-supported crowns: A 12-month prospective study of occlusal analysis

Statement of problemAccording to the concept of implant-protected occlusion, light occlusion and late contact could prevent implants from occlusal overload. However, clinical data demonstrating how light occlusion differs from normal occlusion are lacking. PurposeThe purpose of this prospective clinical study was to characterize the occlusal variation of single posterior implant-supported crowns with or without light occlusion. Material and methodsParticipants with a single missing posterior maxillary or mandibular molar who were to receive implant-supported zirconia ceramic crowns were enrolled. The participants were divided into a light occlusion group, in which a 12-μm articulating film could be removed from the implant-supported crown and opposing natural teeth under the intercuspal position, and a normal occlusion group, in which the articulating film could not be removed. All participants underwent occlusal examinations using the T-scan III system, answered a satisfaction questionnaire using a visual analog scale (VAS), and received regular follow-ups. The participants were evaluated at 0.5, 3, 6, and 12 months after implant-supported crown delivery. The relative occlusal force of the implant-supported crowns, mesial teeth, control teeth (corresponding natural tooth on the dentition contralateral to each implant), and the occlusal contact time of implant-supported crowns were recorded. Moreover, the asymmetry index of the occlusal force and the VAS score were calculated. Two independent-sample tests were used to compare the 2 groups. The Wilcoxon rank sum and Mann‒Whitney tests were used to compare nonnormally distributed data (α=.001). ResultsFifty study participants with a mean ±standard deviation age of 36.97 ±7.34 years (23 men and 27 women aged 20 to 50 years) were followed for 0.5 to 12 months. No obvious complications of overloading were observed in either group. The mean ±standard deviation of the relative occlusal force of implant-supported crowns in the light occlusion group (from 4.91 ±3.52% to 10.34 ±4.35%) was always lower than that in the normal occlusion group (from 10.45 ±4.32% to 18.15 ±4.80%), while the mean ±standard deviation of the occlusal contact time in the light occlusion group (from 0.38 ±0.26 seconds to 0.10 ±0.07 seconds) was significantly later than that in the normal occlusion group (from 0.12 ±0.08 seconds to 0.04 ±0.02 seconds) (P<.001). The value of the asymmetry index of occlusal force remained within the normal range (10%). The VAS score in the normal occlusion group was significantly higher than that in the light occlusion group (P<.001). ConclusionsProviding light occlusion to reduce occlusal force and delay the contact time was not stable over time. The relative occlusal force and occlusal contact time showed a similar development trend in both groups, and no obvious signs of occlusal overloading were observed in this study. Long-term follow-up is necessary for implant-supported prostheses because of the continuous increase in occlusal force.

Occlusion as a predisposing factor for peri-implant disease: A review article.

The restoration of dental implants presents a unique challenge due to the intrinsic biomechanical differences between osseointegrated implants and natural teeth, and their subsequent responses to occlusal loading. However, controversy exists regarding the role that occlusion plays in the physiology of the peri-implant complex. To provide an overview of the scientific literature regarding occlusion as it relates to implant dentistry and peri-implant disease. This article presents a narrative review on occlusal loading and its potential effects on the peri-implant complex, as well as some generally accepted guidelines for occlusion in implant dentistry. Although there is strong evidence linking occlusal factors to mechanical complications of dental implants, the same cannot be said regarding biological complications. There is no clear scientific evidence on the relationship between occlusal overload and peri-implant disease. However, occlusal overload may be an accelerating factor for peri-implant disease in the presence of inflammation. As the biomechanical properties of dental implants differ from that of the natural dentition, modifications to classic concepts of occlusion may be necessary when dental implants are involved. Thus, clinical recommendations are proposed which function to minimize unfavorable occlusal forces on implant restorations and reduce the associated biological and mechanical complications.

Peri-implant bone resorption risk of anterior maxilla narrow single implants: a finite-element analysis

Statement of the problem: Narrow implants have been recommended in high esthetic demand regions to ensure greater buccal bone thickness (BBT) and minimize soft-tissue recession due to insufficient bone support. However, a limited area of bone-implant interface can increase the risk of peri-implant bone resorption due to occlusal forces. Purpose: This article encourages the use of evidence-based finite element analysis to optimize the aesthetic outcomes in maxillary lateral incisor single-supported implant crown by accurate biomechanical planning. This study aimed to analyze the best implant dimensions that would preserve the maximum BBT and avoid peri-implant bone resorption due to occlusal forces. Materials and methods: A maxilla segment was constructed based on anthropological measurements. Four implant diameters (Ø = 3.25; 3.50; 3.75 or 4.00 mm) and two lengths (L = 10 or 13 mm) were simulated. The occlusal force parameters were defined to simulate clinical conditions. The bone resorption risk analysis was based on Frost’s mechanostat theory altering the strain output to strain energy density (SED). The peri-implant bone resorption risk indexes (PIBRri) were calculated by dividing the average of the top ten SED elements of the cortical and trabecular buccal wall by the pathologic resorption limit for each bone. Results: For trabecular bone, only the model Ø4.00L13 exhibited a low PIBRri. For cortical bone, all models presented a low PIBRri, except for models Ø3.25. Conclusion: The selection of a 3.25 mm dental implant to preserve a 2 mm BBT should be avoided since it generates a high peri-implant bone resorption risk induced by occlusal overload.

Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods

The present review aimed to assess the possible relationship between occlusal overload and peri-implant bone loss. In accordance with the PRISMA guidelines, the MEDLINE, Scopus, and Cochrane databases were searched from January 1985 up to and including December 2021. The search strategy applied was: (dental OR oral) AND implants AND (overload OR excessive load OR occlusal wear) AND (bone loss OR peri-implantitis OR failure). Clinical studies that reported quantitative analysis of occlusal loads through digital contacts and/or occlusal wear were included. The studies were screened for eligibility by two independent reviewers. The quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 492 studies were identified in the search during the initial screening. Of those, 84 were subjected to full-text evaluation, and 7 fulfilled the inclusion criteria (4 cohort studies, 2 cross-sectional, and 1 case-control). Only one study used a digital device to assess excessive occlusal forces. Four out of seven studies reported a positive correlation between the overload and the crestal bone loss. All of the included studies had moderate to serious overall risk of bias, according to the ROBINS-I tool. In conclusion, the reported data relating the occlusal analysis to the peri-implant bone level seem to reveal an association, which must be further investigated using new digital tools that can help to standardize the methodology.

A Review of the Risk Factors Involved in the Late Failure of the Dental Implant

Dental implants are increasingly being used to replace missing or lost teeth. Despite significant advances in materials, techniques, and implant design, implant failure remains a major concern for both the dentist and the patient. The most common causes of implant failure are peri-implantitis and a lack of osseointegration. Other causes of implant failure include occlusal overloading, compromised or poor medical status of the patient, habits that harm oral tissues, and implant selection. The most pressing issue that all implantologists face today is the occurrence of complications and failures in implants. To further improve treatment outcomes, the etiologies and factors associated with implant failures should be identified. Osseointegrated dental implants have long been regarded as the closest substitute for missing teeth.

Modifications of the Dental Hard Tissues in the Cervical Area of Occlusally Overloaded Teeth Identified Using Optical Coherence Tomography.

Background and objectives: Occlusal overloads produce a series of manifestations in teeth, especially attrition and non-carious cervical lesions (NCCL). Optical Coherence Tomography (OCT) can highlight and evaluate tooth lesions. The aim of this study was to examine the changes of dental hard tissues in the cervical area because of occlusal overload by macroscopic examination and using in vitro Swept Source OCT examination. Materials and Methods: The study was performed on 21 extracted teeth with occlusal trauma. After macroscopic and OCT examination, the 2D OCT images were transformed into 3D images using ImageJ software. Statistical analysis of macroscopic and OCT images was performed with Statistical Package for Social Sciences. Results: On 21 teeth, 88 cervical lesions (cracks) were identified. Upper premolars with an occlusal Smith and Knight tooth wear score of 2 had the most NCCL. Statistical analysis revealed significant differences in the median widths of cervical lesions between teeth with score 1 and score 3. Additionally, we obtained statistically significant differences in median widths between the buccal and oral surfaces. Conclusions: These cracks can be considered precursors of NCCL. NCCL can be located on dental surfaces in the cervical area other than the buccal one. A 3D reconstruction of OCT images emphasized that cracks are located especially at enamel level, evolving towards the enamel–dentin junction, with multiple ramifications.

Bruxism Influence on Volume and Interleukin-1β Concentration of Gingival Crevicular Fluid: A Preliminary Study

Bruxism is occlusal behaviour that often leads to stomatognathic system overload. Inflammatory markers in the periodontium are detectable in the gingival crevicular fluid (GCF). GCF production fluctuates due to various factors. Our study aimed to assess the effect of tooth clenching or grinding on GCF volume and proinflammatory IL-1β concentration in GCF. This pilot study was carried out on 20 participants aged 21 to 28 with good general health (per 10 people studied and control groups). GCF volume was measured with Periotron 8010 after absorbing for 30 s with PerioPaper strips. Twelve samples were collected from each patient—the buccal and lingual surfaces of teeth 16, 11, 24, 36, 31, and 44 were included. Laboratory examination of IL-1β concentration was performed. In patients with pathological tooth wear, a tendency to increase GCF secretion and IL-1β concentration in GCF was found. GCF volumes were higher in posterior teeth, while IL-1β levels were higher in anterior teeth. Crevices at the molars seem to have a potential predictive value in diagnosing periodontal microinflammation in patients with probable bruxism. Due to occlusal overload, these bruxists are more prone to microinflammatory processes in the periodontium. Further studies in a broader group are required to confirm this correlation.

Yerleştirme Sonrası İyileşme Başlığı ile Kapatılan İmplantlarda İlk Yılda Marjinal Kemik Kaybı Daha Az mı Görülür?

Background: Early peri-implant crestal bone loss during the healing period and the first year on function, is often greater than the bone loss occurring in the following years. Several factors affecting marginal bone loss have been described; such as surgical trauma, flapped or flapless procedures, occlusal overload, microgap and implant crest module. The aim of this study; was to compare the amount of first year peri-implant bone loss in implants closed with cover screw or healing cap. Material and Methods: Patients with same brand, posterior single tooth implants included in this prospective study and divided into two groups. In group I, after implant placement healing cap was placed while in group II, cover screw was placed before primary closure. Panoramic radiographs, taken before and after the implant surgery and after 1 year follow up, were used in bone loss evaluations. Peri-implant bone loss measurements were performed digitally in computer assisted software programme. Results: Thirty implants included in the study with fourteen implants in group I and sixteen implants in group II. There were no perioperative or postoperative complications and no implant failure in all patients. After the first year, mean marginal bone loss was 0.7014 mm (0.2477 mm standard deviation) in group I and 1.3156 mm (0.0943 mm standard deviation) in group II. This 0.6142 mm difference was found statistically significant. Conclusion: Placing healing cap instead of cover screws may prevent periosteal tissue pressure on the crestal bone and reduce the amount of marginal peri-implant bone in the first year.

An Itemized Study on Peri-implant Diseases after Insertion of Restorations

Regardless of the type of implant, the loss of the implant crestal bone in the first year during post-implant-treatment and after functioning by prosthetic treatment is often greater than that of the following year. Possible causes for early implant bone loss include surgical trauma, occlusal overload, peri-implantitis, microgap, biological width, and crest modules of the implant itself. Plaque index and Gingival index values were also foundsignificantly higher for implants without KM(keratinized mucosa). KM of at least 2 mm should be maintained.Contour of implant restoration is known as one of the risk indicators of peri-implantitis.Prevalence of peri-implantitis was significantly greater in the bone-level group when the emergence angle was &gt;30 degrees compared to an angle ≤30 degrees. Emergence angle of &gt;30 degrees is a signific ianndti cra-istokr for peri-implantitis and convex profile creates an additional risk for bone-level implants, but not fo rtis-suelevel implants. Biocom-patible materials should be used for all implant prosthetics, especially f otrhmeation of high polished surfaces with a reasonable appearance on the transmucosal part of the imp rlaensttorations.Bacterial products of the biofilm provoke an immune response in the gingival tissues. As btihoefilm matures-more complex inter-reactions occur and bacteria with more virulent qualities apprpoevaork,ing a more compleximmune system response. Inflammation and immune response cannot be resolved until the bacteria biofilm is removed. To minimize the incidence of complications, dental professionals should make great effort in choos-ing reliable components and materials for implant- supported FDPs and the patients should be placed in wellstructured maintenance system after treatment.

Implant Fracture: A Narrative Literature Review

Implants fracture is a rare but possible complication that leads to implants failure after prostheses delivery. Mechanical properties play a key role in the failure of dental implant systems. The aim of this narrative review was to evaluate the existing evidence in identifying etiology risk factors for implants fracture. The focused question was to evaluate whether there was any possible factors influencing the fracture of dental implants. A literature search of papers written in English, published from 1967 to July 2021, and reporting incidence of implants fracture in human with at least 15 participants (and one year of follow-up) was conducted using PubMed database including MeSH and free text terms and filters. Selected manuscripts were analyzed and discussed. The outcomes were the incidence of implants failure due to a fracture and the associated risk factors. A total of 96 articles were initially selected, but only eight articles were included according to the search criteria (two systematic reviews and six retrospective evaluation). Incidence of implants fracture ranged from 0.2 to 2.3%, with a mean value of 0.52%. Poor implant planning, including implant design and diameter, and occlusal overloading, were the most common variables associated with implants fracture. Implant removal is the only possible treatment and hence prevention, including stability of the marginal bone loss, is mandatory.

Implant Overloading Considerations for Implant Assisted Overdentures .

The loss of retention and stability are considered the most common prosthetic problems that face prosthodontics in complete denture patients especially with continued residual ridge resorption, which increased the number of patients’ seeking improvement of the retention and stability in order to use their dentures. The implant supported overdenture is considered the best option of treatment to solve these problems. Implants may be subjected to occlusal overloading during function which will negatively affect the prognosis of implant osseintegration. This encouraged us to review the literature concerning the factors affecting implant assisted overdentures (IAOD) overloading and how to control them to the benefit and comfort of the patient as well as longevity of the prosthetic.