Influence of marginal bone loss on peri-implantitis: systematic review of literature

J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1045 Journal section: Oral Surgery Publication Types: Review Influence of marginal bone loss on peri-implantitis: Systematic review of literature Alba Carrasco-García 1, Lizett Castellanos-Cosano 2, José-Ramón Corcuera-Flores 3, Antonio Rodríguez-Pérez 4, Daniel Torres-Lagares 5, Guillermo Machuca-Portillo 6 1 PhD student. School of Dentistry, University of Seville 2 Associate Professor. Oral Surgery, School of Dentistry, University of Seville. University of Fernando Pessoa Canarias 3 Associate Professor, Oral Surgery, School of Dentistry, University of Seville 4 Full-time Professor, School of Dentistry, University of Fernando Pessoa Canarias 5 Full-time Professor, School of Dentistry, University of Seville 6 MD, DDS, PhD, Professor and Chairman of Special Care Dentistry, School of Dentistry, University of Seville, Spain Correspondence: School of Dentistry, University of Seville C/Avicena s/n, 41009 Sevilla, Spain [email protected] Received: 16/08/2019 Accepted: 09/09/2019 Abstract Background: The marginal bone of dental implants is subjected to slight load modifications over time, conditioning implant survival. Objective: Perform a systematic review of the literature analyzing the factors that contribute to marginal bone loss (MBL) and the subsequent development of peri-implantitis. Material and Methods: Bibliographic research in the databases PubMed, Medline and Scopus between 2010 and 2018 was performed. The inclusion criteria were articles published in the last 10 years and that were in English or Spanish, that were carried out on humans, that were cohort studies, that included cases and controls or that used randomized clinical trials. Exclusion criteria removed articles that contained clinical cases, case series or systematic reviews. Results: A total of 90 articles were analyzed that examined all the factors reported in the literature, such as idiosyncratic factors, toxic habits, systemic drugs and implant characteristics (diameter, length, type surface, implant connection, implant design and type of platform at the moment of the prosthetic load). Discussion: Patient characteristics and associated pathologies must be taken into account when assessing MBL. MBL in all dental implants can be considered independent of the type of prosthetic rehabilitation and the moment of load; this was emphasized. The MBL is smaller in dental implants with rough surfaces, switch platforms and infracrestal localization, as they are of multifactorial origin. Conclusions: All the reviewed articles maintain a common criterion regarding the concept and measurement of the MBL and highlighting the importance of radiodiagnosis for quantification. Longterm prospective studies with unified criteria are needed to reduce bias by identifying the most relevant factors in MBL. Key words: Marginal bone loss, dental implant, peri-implantitis. doi:10.4317/jced.56202 http://dx.doi.org/10.4317/jced.56202 Article Number: 56202 http://www.medicinaoral.com/odo/indice.htm © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488 eMail: [email protected] Indexed in: Pubmed Pubmed Central® (PMC) Scopus DOI® System Carrasco-García A, Castellanos-Cosano L, Rodríguez-Pérez A, Corcuera-Flo- res JR, Torres-Lagares D, Machuca-Portillo G. Influence of marginal bone loss on peri-implantitis: Systematic re-view of literature. J Clin Exp Dent. 2019;11(11):e1045-71. http://www.medicinaoral.com/odo/volumenes/v11i11/jcedv11i11p1045.pdf J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1046 Introduction Rehabilitation through dental implants has a long history. Recently, the analysis and relevance of bone remodeling shows that rehabilitation occurs from the moment of dental implant placement and the osseointegration process and from the implant’s subsequent prosthetic rehabilitation and submission to masticatory loads, as well as the conservation and modification of the soft tissues that surround dental implants to achieve adequate function (1). The study of these variables begins with Albrektsson et al. 1986 (2) and continues with Misch et al. 2008 (3), who showed how remodeling of the bone surrounding the crestal area of the implant takes place during the first year after implant placement. A loss of up to 2 mm of bone around the neck has been considered to be normal. However, the subsequent remodeling of the surrounding bone must continue be evaluated, since it can ultimately lead to the loss of the dental implant. To assess a dental implant’s success, different criteria have been described, some of which are still valid today: absence of peri-implant radiolucency, absence of mobility, annual bone loss of less than 0.2 mm after the first year and absence of pain, infection and paresthesias (2). However, new criteria have been incorporated in an attempt to establish scales of implant quality by establishing groups: Group I includes optimal health conditions, Group II includes satisfactory health with stable implants and a history of clinical problems, Group III includes those who have implants with compromised health and Group IV implants are considered failures (3). Many factors that may influence marginal bone loss (MBL) have been described in the scientific literature: systemic factors of the patient (patient’s baseline pathology, toxic habits), local factors (history/presence of periodontal disease, poor oral hygiene, quality and bone quantity) and characteristics of the implant (surface, diameter, length and morphology) (4-8). This systematic review aimed to examine previous articles published in the scientific literature that examine which factors contribute to MBL and the development of peri-implantitis. Material and Methods This work has been carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement published in 2009 (9). The PI-CO question was asked: What factors influence the initial MBL after the placement of a dental implant and its progression over time? To answer this, a bibliographic search was carried out using PubMed, Medline and Scopus databases and was limited to works published during 2010-2018. The keywords used for the search were “Marginal bone loss,” “dental implant” and “peri-implantitis.” The inclusion criteria for the research literature were articles published in the last 10 years and that were in English or Spanish, that were carried out on humans and that included the following types of studies: cohort studies, cases and controls or randomized clinical trials. Exclusion criteria removed articles that contained clinical cases, case series or systematic reviews. All the information was obtained from the articles selected by one of the authors (ACG). The variables included general information, such as the author, year of publication, type of study, sample size, number of patients evaluated and number of implants placed. Specific variables included the definition used by the authors for MBL, which types of radiography were used for the analysis of MBL, which factors were evaluated in the study and the results obtained. Results A systematic research of the PubMed database was carry out with the following research strategies: 1. ((marginal[All Fields] AND (“bone diseases, metabolic”[MeSH Terms] OR (“bone”[All Fields] AND “diseases”[All Fields] AND “metabolic”[All Fields]) OR “metabolic bone dis-eases”[All Fields] OR (“bone”[A- ll Fields] AND “loss”[All Fields]) OR “bone loss”[All Fields])) AND (“peri-implantitis”[MeSH Terms] OR “peri-implantitis”[All Fields] OR “pe-riimplantitis”[A- ll Fields])) AND ((Clinical Trial[ptyp] OR Observational Study[ptyp] OR Con-trolled Clinical Trial[ptyp]) AND “2008/12/01”[PDat]: “2018/11/27”[PDat] AND “hu-mans”[MeSH Terms] AND (English[lang] OR Spanish[lang])). A total of 61 articles were found, of which, after reading the title and summary, 36 were excluded for not complying with the established inclusion criteria; 13 articles were selected (Fig. 1). 2. ((marginal[All Fields] AND (“bone diseases, metabolic”[MeSH Terms] OR (“bone”[All Fields] AND “diseases”[All Fields] AND “metabolic”[All Fields]) OR “metabolic bone dis-eases”[All Fields] OR (“bone”[A- ll Fields] AND “loss”[All Fields]) OR “bone loss”[All Fields])) AND (“dental implants”[MeSH Terms] OR (“dental”[All Fields] AND “implants”[All Fields]) OR “dental implants”[All Fields] OR (“dental”[All Fields] AND “implant”[All Fields]) OR “dental implant”[All Fields])) AND ((Clinical Trial[ptyp] OR Observational Study[ptyp] OR Controlled Clinical Trial[ptyp]) AND “2008/12/01”[PDat]: “2018/11/27”[PDat] AND “humans”[MeSH Terms] AND (English[lang] OR Spanish[lang])). A total of 619 articles were obtained, and after reading the title and abstract, 82 articles were selected (Fig. 2). After the analysis of the articles obtained from both research attempts, five repeated articles were found, resulting in 90 articles being analyzed. The articles included in the systematic review of the lite- J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1047 Fig. 1: Flowchart with the keywords “marginal bone loss” and “peri-implantitis.” rature with the research topic of “marginal bone loss and peri-implantitis” and with the research “marginal bone loss and dental implant” can be observed in Table 1, 1 continue 1-18. Discussion Peri-implantitis was initially described as an infection with pathological changes in the peri-implant tissues (10). Subsequently, different criteria have been defined for its diag-nosis: bleeding, probing depth of higher than 5 mm, exposure of 3 turns or more of the implant’s surface (11) or radiographic observation of MBL, which is defined as bone lost around the crestal area of the dental implant (12). -MBL Concept Several authors defined MBL as the position of the marginal bone based on the position of the crestal bone that is in contact with the implant compared to the more coronal crestal reference point of the implant. Therefore, the MBL measured radiographically mesially and distally would be the vertical distance from the crestal reference point of the implant to the first contact with the bone with the implant at the axial level and is measured parallel to it (13). The dimensional stability of the tissues is analyzed one year after the prosthetic load of the implant, since during the first year, different authors establish MBL limits of 1.5-2 mm (14), determining a single value of 1.8 mm (15) against the 1.5 mm subsequently established (16). Some authors suggested that after the first year, an MBL greater than 0.2 mm per year can take place (2). -MBL Diagnostic Tests For the proper assessment of MBL around dental implants, it is essential to go through complementary diagnostic tests (3). Among the most important radiological tests, we observed the panoramic radiography or orthopantomography and the periapical radiography; these tests will only allow researchers to measure the proximal (mesial and distal) MBL of the implant vertically (3). On the other hand, the conical beam tomography (CBCT) offers us transversal cuts, giving us the possibility to obtain a threedimensional evaluation of the MBL and measure the MBL of the vestibular and lingual area of the implant aside from being able to obtain values in the horizontal sense (17). In addition, with respect to axial tomography, the exposure time, radiation dose and economic cost are reduced (18). However, only 4 of the 90 included studies used cone beam tomography, and J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1048 Fig. 2: Flowchart with the keywords “marginal bone loss” and “dental implant.” 8 of them resorted to panoramic radiography, whereas the vast majority carried out periapical radiographs of the implants by performing a parallel technique with the help of positioners (Table 1, 1 continue 1-18). -MBL Quantification When quantifying MBL, some authors used different software (19) and even used magnifying glasses to be more exhaustive with the measurement (20). All the studies included in this review expressed this MBL quantitatively in millimeters, except for the study performed by Corcuera et al. 2016 (21), in which Lagervall and Jansson’s classification was used (22). This classification gives grade 0 if there is no MBL, grade 1 when the loss is equal to or less than 1/3 of the length of the implant, grade 2 if the loss is greater than 1/3 but less than 2/3 of the length of the implant and grade 3 if it suffers 2/3. Corcuera et al. 2016 made a modification to this classification, incorporating a grade 4 that includes implants that were unsuccessful or non-surviving (21). -MBL Influential Epidemiological Factors The main idiosyncratic patient factors recorded in the studies reviewed were age, gender, toxic habits and systemic pathology (osteoporosis, osteopenia, Interleukin-1b levels), in addition to the medication administered (bisphosphonates) (23-27). Few studies focused on assessing MBL and highlighted the presence of systemic pathology, including a patient’s medication and/or their toxic habits. Although greater MBL has been observed in smoking patients, independently of the type of implant rehabilitation, MBL sometimes duplicates these results independently of the type of implant rehabilitation applied (28). Sayardoust et al. 2017 (25) indicated that MBL was higher in the mechanized implants of smoking patients at 90 days, with a higher expression of the proinflammatory cytokine IL-6 and a lower expression of the osteogenic and osteocalcin gene. Predictors of MBL are reflected in smoking, bleeding as a result of probing at 90 days, an expression of factor 1 alpha and an expression of proinflammatory cytokine at 90 days (25). Corcuera et al. 2017 (21) concluded that patients with Down syndrome have significantly higher MBL (p < 0.001) if one implant per patient is selected (p < 0.05). They also observed a greater loss of implants, especially in those with greater MBL (p < 0.01). In the case group, an increase in MBL (p < 0.05) and greater implant loss (p < 0.01) was also observed with age. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1049 Author et al. year Reference Study type Sample size Criteria used to define MBL Radiography Evaluated variables Results Corcuera- Flores et al. 2017 Four years of survival and marginal bone loss of implants in patients with Down syndrome and cerebral palsy. Clin Oral Investig. 2017 Jun;21(5):1667-1674 Retrospective 19 patients 172 implants MBL in thirds (Lagervall and Jansson’s proposed radiological classification; does not specify program used). OPG Implant length Medical pathology (Down syndrome vs. cerebral palsy) MBL was significantly higher in all samples (p < 0.001). MBL (p < 0.05) and implant loss (p < 0.01) increased with age. The three-unit fixed dental prosthesis showed higher MBL (p < 0.05). Down syndrome had a higher MBL than cerebral palsy (entire sample: p < 0.0001; one implant per patient: p < 0.05). All patients with Down syndrome saw some damage to bone support (entire sample: p < 0.0001; one implant per patient: p < 0.05). Implant loss occurred only in Down syndrome patients (p < 0.00001). Cooper et al. 2016 Comparison of Marginal Bone Changes with Internal Conus and External Hexagon Design Implant Systems: A Prospective, Randomized Study. Int J Periodontics Restorative Dent. 2016 Sep- Oct;36(5):631-42 Prospective 45 patients 93 implants MBL in mm (does not specify program used) Intraoral Rx with paralyzer (parallel technique) MBL Implant connection. Interproximal papilla level The mean marginal bone level change from implant placement to 3 years was -0.25 ± 0.60 mm and -0.5 ± 0.93 mm for internal conus design implants and external hex design implants, respectively. The change recorded from permanent restoration to 3 years was a gain of 0.31 ± 0.41 mm versus 0.04 ± 0.51 mm for ICI and EXI implants, respectively (P < .05). Mendoza- Azpur et al. 2016 Assessment of Marginal Peri-implant Bone-Level Short-Length Implants Compared with Standard Implants Supporting Single Crowns in a Controlled Clinical Trial: 12-Month Follow-Up. Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):791-795. Clinical trial 82 patients MBL in mm measured with ImageJ software (NIH) Intraoral Rx (parallel technique) Type of implant (shorts vs. conventional) Soft tissue stability A statistically significant difference was found in favor of the standard-length implants after 12 months, with greater gingival recession around the implant; however, bone loss in the short implants did not exceed 0.53 mm. The treatment with 5.5- to 7-mm-length implants is as reliable as treatment with 10- or 12-mm- length implants. Koutouzis et al. 2015 The Effect of Interimplant Distance on Peri-Implant Bone and Soft Tissue Dimensional Changes: A Nonrandomized, Prospective, 2-Year Follow-Up Study. Int J Oral Maxillofac Implants. 2015 Jul-Aug;30(4):900- Prospective 30 patients 60 implants MBL in mm measured with MiPacs, Medicor Imaging Intraoral Rx with parallelizer (Dentsply Rinn; parallel technique) Marginal and midproximal bone loss between implants There were no statistically significant differences in marginal and midproximal bone crest loss between the different groups at any time. Table 1: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1050 Table 1 continue: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Türk et al. 2013 Marginal bone loss of two implant systems with three different superstructure materials: a randomised clinical trial. J Oral Rehabil. 2013 Jun;40(6):457-63 Clinical trial 33 patients 77 implants MBL in mm measured with software (RAIN v:12.27) Intraoral Rx with parallelizer (parallel technique) Implant system Prosthetic material Prosthetic materials were found to have greater effect (β = 0.575, P = 0.015) on crestal bone loss than implant systems (P > 0.05). The porcelain fused to base metal alloy restorations showed higher crestal bone loss than noble metal alloybased restorations (P = 0.003) at 3 months, (P = 0.038), at 6 months and (P = 0.00) at 12 months; however, the crestal bone loss differences between noble metal alloy and zirconia were not significant (P = 0.629) at 3 months, (P = 0.974) at 6 months and (P = 1) at 12 months. Bressan et al. 2017 The influence of repeated abutment changes on peri-implant tissue stability: 3-year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implantol. 2017;10(4):373-390 Clinical trial 80 patients 128 implants MBL in mm measured with Scion Image (Scion Corporation, Frederick, MD, USA) software Intraoral Rx with parallelizer (parallel technique) Implant location (I,C, PM, M). Implant diameter Postextraction implants Unitary crown or bridges Mean peri-implant MBL 3 years after loading was 0.07 (0.18) mm for the definitive abutment group and 0.50 (0.93) mm for the repeated abutment changes group (difference = 0.43 mm; CI 95%: 0.13, 0.74; P = 0.007). Pisoni et al. 2016 Flapless Versus Traditional Dental Implant Surgery: Long-Term Evaluation of Crestal Bone Resorption. J Oral Maxillofac Surg. 2016 Jul;74(7):1354-9 Prospective 40 patients 69 implants MBL in mm (does not specify program used) Rx does not specify Surgical technique with or without flap MBL No statistical differences were found in peri-implant bone resorption between the 2 groups (open flap surgery vs. flapless surgery) at the basal, implant loading and 3-year control recordings. Abtahi et al. 2016 Randomised trial of bisphosphonate-coated dental implants: Radiographic follow-up after five years of loading. Int J Oral Maxillofac Surg. 2016 Dec;45(12):1564-1569. Clinical trial 32 patients 56 implants MBL in mm Measured with diagnostic imaging (Sectra PACS; Sectra AB, Linko  ping, Sweden) Intraoral Rx with parallelizer (parallel technique) Bisphosphonate treatment The median MBL for control implants was found to be 0.70 mm, which is less than usually reported in the literature. The bisphosphonate-coated implants showed even less resorption (median 0.20 mm). The median difference within each pair of implants after 5 years of use was 0.34 mm (95% confidence interval 0.00-0.75 mm; P=0.04). Gultekin et al. 2013 Clinical evaluation of marginal bone loss and stability in two types of submerged dental implants. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):815-23. Clinical trial 27 patients 104 implants MBL in mm Measured with software (Iluma DVT software, IMTEC Imaging) TAC Implant design Implant platform design Implant stability (insertion torque) One year after loading, mean crestal bone loss was 0.35 ± 0.13 mm for test implants and 0.83 ± 0.16 mm for control implants, showing a significant difference. Primary stability was significantly higher in the test group (TG) than in the CG, but this difference disappeared after 3 months of healing prior to loading. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1051 Table 1 continue-1: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Khorsand et al. 2016 Effect of Microthread Design on Marginal Bone Level Around Dental Implants Placed in Fresh Extraction Sockets. Implant Dent. 2016 Feb;25(1):90-6 Clinical trial 30 patients 41 implants MBL in mm measured with Trophy 2000 software (Trophy windows access software; Paris, France) Intraoral Rx with parallelizer (parallel technique) Implant length Implant location (I, C, PM, M) Implant design At month 3, the microthread groups have been associated with more MBL than the CG (P = 0.04). At months 6 and 12, both groups had comparable bone levels (P = 0.21). Lee et al. 2016 A Long-Term Prospective Evaluation of Marginal Bone-Level Change Around Different Implant Systems. Int J Oral Maxillofac Implants. 2016 May- Jun;31(3):657-64 Prospective 54 patients 135 implants MBL in mm measured with UTHSCSA Image Tool (version 3.00 for Windows, University of Texas Health Science) Intraoral Rx (parallel technique) Implant system Implant surface Unitary crown or bridges The rough-surface implants and the machined coronal aspect implants did not exhibit statistically significantly different MBL, whereas the microthreaded coronal aspect implants exhibited significantly less MBL (P = .0015). Schincaglia et al. 2016 Marginal Bone Response Around Immediate- and Delayed-Loading Implants Supporting a Locator- Retained Mandible Overdenture: A Randomized Controlled Study Int J Oral Maxillofac Implants. 2016 Mar- Apr;31(2):448-58 Clinical trial 30 patients 60 implants MBL mm measured with Image J, version 1.42, National Institutes of Health) Intraoral Rx (parallel technique) Moment of implant loading (immediate or deferred) Implant stability (insertion torque) Implant length A statistically significant difference was observed at 12 months, with less radiographic bone loss in the immediately implants group. Insertion torque and implant length were not correlated with radiographic bone loss. Also, no difference in frequency of maintenance visits and prosthetic complications was reported between the groups. Elsyad et al. 2016 Circumferential bone loss around splinted and nonsplinted immediately loaded implants retaining mandibler overdentures: A randomized controlled clinical trial using cone beam-computed tomography. J Prosthet Dent. 2016 Nov;116(5):741-748 Clinical trial 30 patients 60 implants MBL mm Measured with On- Demand3DApp Software; CyberMed Inc CBCT MBL Prosthetic rehabilitation (overdenture in implants splinted with bar or without splinting) Vertical bone loss and horizontal bone loss increased significantly at 3 years after insertion (T3) compared with 1 year (T1) for both groups (P < .005). After 3 years, vertical bone loss was 1.36 ± 0.57 mm and 1.0 ± 0.44 mm and horizontal bone loss was 0.88 ± 0.48 mm for with ball attachment (BA) and 0.77 ± 0.53 mm for bar attachment (RA). At T1 and T3, a BA had more significant vertical bone loss than an RA (P < .001), while horizontal bone loss did not differ significantly between groups. For both groups, a significant difference was found in vertical bone loss and horizontal bone loss between implant sites (P < .001). J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1052 Table 1 continue-2: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Slot et al. 2016 Maxillary overdentures supported by four or six implants in the anterior region: 5-year results from a randomized controlled trial. J Clin Periodontol. 2016 Dec;43(12):1180-1187 Clinical trial 50 patients 250 implants MBL in mm Intraoral Rx with parallelizer (parallel technique) Hybrid prosthesis on 4 or 6 implants (number of implants) In patients with functional complaints of their maxillary denture, bar-supported overdentures on four implants in the anterior maxillary region were not inferior to overdentures supported by six implants after 5 years of function. Clinical function was good, with no difference in clinical parameters between the groups. Negri et al. 2014 The effect of age, gender, and insertion site on marginal bone loss around endosseous implants: results from a 3-year trial with premium implant system. Biomed Res Int. 2014;2014:369051 Clinical trial 252 patients 632 implants MBL in mm measured with OsiriX Imaging Software OPG Age Gender Implant location (maxilar o mandible) Implant diameter Overall MBL was 0.8 mm ± 0.03 (mean ± SEM). Higher MBL was observed around implants in the maxilla than in the mandible (P < 0.007). A relationship between implant diameter and MBL (P < 0.0001) was observed in male and, more limitedly, female patients. Older patients had higher MBL in the maxilla, but not in the mandible (P < 0.0001). MBL progressively increased with age in male patients, but reached a peak in the 50- to 60-year age group in the female subset (P < 0.001). Fernández- Formoso et al. 2012 Radiographic evaluation of marginal bone maintenance around tissue-level implant and bone-level implant: a randomised controlled trial. A 1-year followup. J Oral Rehabil. 2012 Nov;39(11):830-7. Clinical trial 54 patients 114 implants MBL in mm measured with NHI Image Intraoral Rx (parallel technique) Implant platform design Mean of bone loss with platform-switch- ing implants was -0.01 mm, and the mean of bone loss with standard platform implant was 0.42 mm. Outcomes of this study indicated that the platformswitching design could preserve the crestal bone levels to the 1-year followup. There was a statistically significant difference in MBL. Ma et al. 2010 Marginal bone loss with mandibler two-implant overdentures using different loading protocols and attachment systems: 10-year outcomes. Int J Prosthodont. 2010 Jul-Aug;23(4):321-32. Retrospective 106 patients 212 implants MBL in mm measured with x7 magnification, using a peak magnifying glass (which had a scale in tenths of a millimeter) Intraoral Rx with parallelizer (parallel technique) Implant surface Attachments (ball retainers vs. locator) Annual MBL progressed at low levels after the first year with episodes of bone loss and gain. There was stability in marginal bone levels over the long term, with the majority of remodeling occurring during the first year of function. Roughened implant surfaces may be beneficial during the early remodeling period. The amount of MBL in the first year of loading differed significantly by loading protocol and implant surface, whereas the attachment system had only a minor influence. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1053 Table 1 continue-3: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Hof et al. 2014 Impact of insertion torque and implant neck design on peri-implant bone level: a randomized split-mouth trial. Clin Implant Dent Relat Res. 2014 Oct;16(5):668-74 Clinical trial 21 patients 84 implants MBL in mm; does not specify program used Intraoral Rx (parallel technique) Implant stability (insertion torque) Implant design Interleukin-1b levels No significant influence of insertion torque or implant neck design on peri-im- plant bone level was found. Protein levels of interleukin-1β in the peri-implant crevicular fluid revealed no difference between both insertion torque groups and different neck designs. Song et al. 2009 Comparative analysis of peri-implant marginal bone loss based on microthread location: a 1-year prospective study after loading. J Periodontol. 2009 Dec;80(12):1937-44 Prospective 20 patients 40 implants MBL in mm; does not specify program used Intraoral Rx with parallelizer (parallel technique) Implant design The average bone loss was 0.16 (SD: 0.19) mm in the group with microthreads placed at the implant top and 0.30 (SD: 0.22) mm in the group with microthreads placed 0.5 mm below the implant top after 1 year of functional loading. The paired t test revealed a significant difference in crestal bone loss between groups A and B in individual patients (P = 0.004). No significant differences were found between the two groups for the gingival parameters. Froum et al. 2017 Survival Rates and Bone and Soft Tissue Level Changes Around One-Piece Dental Implants Placed with a Flapless or Flap Protocol: 8.5-Year Results Int J Periodontics Restorative Dent. 2017 May/Jun;37(3):327- 337 Retrospective 52 patients 108 implants MBL in mm; measured with Image- Pro Insight version 8.0.4, Media Cybernetics Intraoral Rx (parallel technique) Surgical technique with or without flap Implant and abutment one piece Analysis suggested decreasing mean levels of bone loss with time (P < .001). Moreover, there was 0.8-1.0 mm of bone loss through year 1.5, which decreased to 0.3 mm at 8.5 years (P < .05). There was no statistically significant difference in probing pocket depth (PPD) or bleeding on probing over time. Similar mean levels of PPD were found in flap and flapless groups (mean [SD] = 2.4 [0.3] and 2.2 [0.4] mm, respectively [P = .18]), as well as similar rates of BoP (22.8% vs. 17.9%, respectively). Aimetti et al. 2015 Soft tissue and crestal bone changes around implants with platform-switched abutments placed nonsubmerged at subcrestal position: a 2-year clinical and radiographic evaluation. Int J Oral Maxillofac Implants. 2015 Nov- Dec;30(6):1369-77 Retrospective 40 patients 58 implants MBL in mm measured with Image J software Intraoral Rx (parallel technique) Implant location (maxilar o mandible) Bone quality (2 or 3) Number of implants From implant insertion to the 2-year follow-up, the mean bone loss was 0.32 ± 0.37 mm. No significant differences related to sex, implant site and bone density were observed. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1060 Table 1 continue-10: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Becker et al. 2013 Prospective clinical trial evaluating a new implant system for implant survival, implant stability and radiographic bone changes. Clin Implant Dent Relat Res. 2013 Feb;15(1):15-21. Clinical trial 66 patients 10 implants MBL in mm measured with ImageJ Intraoral Rx with parallelizer (parallel technique) Implant diameter Implant location Bone quality Implant stability Between examinations, there was an average -0.6 mm of bone loss, which was statistically significant (p = 0.03). On average, 4.0-mm-wide implants lost 0.1 mm of bone when compared with 5-mm- wide implants. These differences were insignificant (p = 0.86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five-milli- meter-wide implants lose 0.2 mm more than 4.0-mm-wide implants (p = 0.7). Maxillary incisors lose the least amount of bone at 0.152 mm (p = 0.33). Cochran et al. 2009 A prospective multicenter 5-year radiographic evaluation of crestal bone levels over time in 596 dental implants placed in 192 patients. J Periodontol. 2009 May;80(5):725-33. Prospective 192 patients 596 implants MBL in mm (does not specify program used) Intraoral Rx with parallelizer (parallel technique) Type of implant Implant design (solid screw or hollow cylinder) Prosthetic restoration (single or multiple) Implant length Clinically significant marginal bone remodeling occurred between the implant placement and the final prosthesis placement around one-stage non-submerged titanium implants with a titanium plasma-sprayed surface. Subsequent to that, bone loss observed around implants up to 5 years postloading was minimal. Ryu et al. 2016 Early loading of splinted implants supporting a two-unit fixed partial denture in the posterior maxilla: 13-month results from a randomized controlled clinical trial of two different implant systems. Clin Oral Implants Res. 2016 Aug;27(8):1017- 25 Clinical trial 30 patients 60 implants MBL in mm (does not specify program used) Intraoral Rx with parallelizer (parallel technique) Implant stability (insertion torque) Implant design Bone quality Implant location Both groups exhibited no stability dip during the early phase of healing. The average MBL from the baseline of implant placement for the control and experimental groups was 0.38 and 0.45 mm after 4 weeks and 0.98 and 0.61 mm after 13 months, respectively. Mumcu et al. 2012 The influence of healing type on marginal bone levels of implants supporting mandibler overdentures: a randomized clinical study. Indian J Dent Res. 2012 Jul- Aug;23(4):514-8 Clinical trial 48 patients 96 implants MBL in mm measured with software program CorelDraw 11.0 (Corel Corporation and Coral Ltd., Ottawa, Canada) OPG Healing period (implant submerged or not) The MBL of the implants at 6 months was found to be significantly higher in the submerged healing group (P < 0.05). No statistically significant relation was found between the MBL of implants left to submerged healing and that of implants left to non-submerged healing in the other follow-up periods. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1061 Table 1 continue-11: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Palaska et al. 2016 Influence of placement depth and abutment connection pattern on bone remodeling around 1-stage implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res. 2016 Feb;27(2):e47-56. Clinical trial 81 patients 105 implants MBL in mm measured with DSR (VixWin; Gendex Dental System) Intraoral Rx with parallelizer (parallel technique) Implant location (crestal vs. subcrestal) (M, PM) Implant connection (Morse type or not) The mean (± SE) peri-implant bone loss was recorded as follows. Group 1 (subcrestal, screwed tapered internal connection): 0.68 ± 0.07 mm; group 2 (crestal, screwed and tapered internal connection): 0.79 ± 0.06 mm; group 3 (subcrestal internal conical seal connection): 0.49 ± 0.06 mm; and group 4 (crestal, internal conical seal connection): 0.40 ± 0.07 mm. The statistical analysis revealed significant differences in bone resorption between groups with different abutment connections. Veis et al. 2010 Evaluation of peri-implant marginal bone loss using modified abutment connections at various crestal level placements. Int J Periodontics Restorative Dent. 2010 Dec;30(6):609-17. Prospective 282 implants MBL in mm measured with AxioVision 4.6.3, Carl Zeiss Does not specify the radiographic method used Implant location (crestal, sub and supracrestal) Implant platform design Statistically significant differences were found between subgroups in both straight and platform-switched categories. The only non-statistically significant difference (P = .341) arose when comparing the supracrestal and subcrestal locations in the straight abutment connection group. The platform-switched group exhibited significantly less bone loss (P = .046) only in subcrestal locations. The platform-switched concept was not beneficial during the overall comparison, but it was for the subcrestal location of the abutment connection. The crestal placement of the implant-abutment connection raised the marginal bone resorption in straight and platform-switched abutments. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1062 Table 1 continue-12: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Cehreli et al. 2010 Spontaneous early exposure and marginal bone loss around conventionally and early-placed submerged implants: a double-blind study. Clin Oral Implants Res. 2010 Dec;21(12):1327-33 Retrospective 46 patients 103 implants MBL in mm measured with (ImageJ 1.32j, NIH, Bethesda, MD, USA Intraoral Rx with parallelizer (parallel technique) Postextraction implants or not Provisional prosthetic or not The MBL in the early-placed group (Group 2) was higher than in the conventionally placed group (Group 1) in patients with or without interim prosthesis (P < 0.05). The use of interim prosthesis did not increase the MBL in Group 1, but it led to a higher MBL in Group 2. The percentage of nonexposed implants in Group 1 was higher than in Group 2 (P = 0.007, odds ratio = 7). Group 1 implants had an 11.5 times greater plaque index score of 0 than those in Group 2 (P = 0.031, odds ratio = 11.5). The differences between the MBL with regards to CSE scores of 0 and 1–4 was significant for both sides in Group 2 and the mesial side in Group 1 (P < 0.05). Tealdo et al. 2014 Immediate versus delayed loading of dental implants in edentulous patients’ maxillae: a 6-year prospective study. Int J Prosthodont. 2014 May-Jun;27(3):207-14 Prospective 49 patients 260 implants MBL in mm (does not specify program used) Intraoral Rx with parallelizer (parallel technique) Moment of implant loading (immediate or deferred) Significantly less bone loss occurred in the immediately loaded implants (mean: 1.62 mm) compared with the control delayed implant loading (mean: 2.44 mm) over the study’s 6-year follow-up period. Karabuda et al. 2011 Stability, marginal bone loss and survival of standard and modified sand-blasted, acidetched implants in bilateral edentulous spaces: a prospective 15-month evaluation. Clin Oral Implants Res. 2011 Aug;22(8):840-9. Prospective 22 patients 96 implants MBL in mm measured with software (Diagora for Windows, Sooredex, Tuusula, Finland) OPG Implant surface (SLA or SLA modified: sandblasting and acid) At the loading stage, modSLA implants showed a significantly lower MBL (0.18 ± 0.05 mm) than SLA implants (0.22 ± 0.06 mm; P = 0.002). In the loading stage, the RFA value of the modSLA implants (60.42 ± 6.82) was significantly higher than that of both implant types in the surgical stage (55.46 ± 8.29 and 56.68 ± 8.19) and after 1 (56.08 ± 7.01 and 55.60 ± 9.07) and 3 weeks of healing (55.94 ± 5.95 and 55.40 ± 6.50 for SLA and modSLA implants, respectively). Tallarico et al. 2016 Dental implants treatment outcomes in patient under active therapy with alendronate: 3-year follow-up results of a multicenter prospective observational study Clin Oral Implants Res. 2016 Aug;27(8):943-9 Prospective 40 patients 98 implants MBL in mm measured with DFW 2.8 for Windows, Soredex, Tuusula, Finland Intraoral Rx with parallelizer (parallel technique) MBL after biphosphonate intake Oral bisphosphonate therapy did not appear to significantly affect implant survival and success in cases with an accurate treatment time selection, minimally invasive surgical approach and constant follow-up. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1063 Table 1 continue-13: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Felice et al. 2016 Posterior jaws rehabilitated with partial prostheses supported by 4.0 x 4.0 mm or by longer implants: One-year post-loading results from a multicenter randomised controlled trial. Eur J Oral Implantol. 2016 Spring;9(1):35-45. Clinical trial 150 patients 240 implants MBL in mm measured with OsiriX (Pixmeo Sarl, Bernex, Switzerland) software Intraoral Rx with parallelizer (parallel technique) Implant length Implant stability (insertion torque) No statistically significant differences in bone level changes between short and long implants occurred for 1 year (mean difference = 0.038 mm; 95% CI: −0.068 to 0.138; P = 0.198). Lee et al. 2016 A Two-Year Evaluation of a Sloped Marginal Contour Implant System Placed in Healed Sites. Int J Oral Maxillofac Implants. 2016 Nov/Dec;31(6):1423-1428. Retrospective 14 patients 18 implants MBL in mm (does not specify program used) Intraoral Rx with parallelizer (parallel technique) Implant location Implant stability (insertion torque) No statistical difference were found related to implant location or implant stability. Vercruyssen et al. 2014 Implant- and patient-centred outcomes of guided surgery, a 1-year follow-up: An RCT comparing guided surgery with conventional implant placement. J Clin Periodontol. 2014 Dec;41(12):1154-60. Clinical trial 59 patients 314 implants MBL in mm measured with imageJ software (National Institutes of Health) Intraoral Rx with parallelizer (parallel technique) Bone quality Implant length Implant diameter Surgical technique (guided or conventional) At a 1-year follow-up, no difference could be found between the implant and patient outcome variables of guided or conventional implant treatment. Esposito et al. 2015 Dental implants with internal versus external connections: 1-year post-loading results from a pragmatic multicenter randomised controlled trial. Eur J Oral Implantol. 2015 Winter;8(4):331-44. Clinical trial 200 patients 327 implants MBL in mm measured with UTHSCSA Image Tool 3.0 software (The University of Texas Health Science Center, Texas, USA) Intraoral Rx with parallelizer (parallel technique) Implant connection (internal vs. external) Implant length Implant diameter Implant location (I, C,PM,M) Bone density Within the limitations given by the difference in neck design and platform-switch- ing between external connection and internal connection implants, preliminary short-term data (1-year post-loading) did not show any statistically significant differences between the two connection types, Jung et al. 2016 Evaluation of a one-piece ceramic implant used for single-tooth replacement and three-unit fixed partial dentures: a prospective cohort clinical trial. Clin Oral Implants Res. 2016 Jul;27(7):751-61. Clinical trial 60 patients 71 implants MBL in mm (does not specify program used) Intraoral Rx with parallelizer (parallel technique) Implant length Implant diameter Implant location (maxilla or mandible) The mean MBL from the implant insertion to the 1-year follow-up after the final prosthetic restoration was 0.78 mm, with a standard deviation of 0.79 mm. After 1 year, the difference was significant. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1064 Table 1 continue-14: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Nickenig et al. 2013 A 5-year prospective radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced microthreaded implants using digitized panoramic radiographs. J Craniomaxillofac Surg. 2013 Oct;41(7):564-8. Prospective 34 patients 133 implants MBL in mm measured with Friacom Dental Office Software 2.4, Friatec AG, Mannheim, Germany OPG Implant surface (rugged microtreated, machined neck) Implant location (PM, M) Implant length The machined-neck group had a mean crestal bone loss of 0.5 mm (0.0–2.3) after the healing period, 1.1 mm (0.0– 3.0) at the 2-year follow-up and 1.4 mm (0.0–2.9) at the 5-year follow-up. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (−0.4 to 2.0) after the healing period, 0.5 mm (0.0 to 2.1) at the 2-year follow-up, and 0.7 mm (0.0 to 2.3) at the 5-year follow-up. The two implant types showed significant differences in marginal bone levels. Cehreli et al. 2010 Marginal bone level changes and prosthetic maintenance of mandibler overdentures supported by 2 implants: a 5-year randomized clinical trial. Clin Implant Dent Relat Res. 2010 Jun 1;12(2):114-21. Clinical trial 28 patients 56 implants MBL in mm measured with ImageJ 1.32j, NIH, USA Intraoral Rx with parallelizer (parallel technique) Type of implant (Branemark vs. Straumann) The MBL around Brånemark implants (1.21 ± 0.1) was higher than around Straumann implants (0.73 ± 0.06) after 5 years of functioning (p = .002). Crespi et al. 2014 Immediate occlusal loading of full-arch rehabilitations: screw-retained versus cement-retained prosthesis. An 8-year clinical evaluation Int J Oral Maxillofac Implants. 2014 Nov- Dec;29(6):1406-11. Prospective 28 patients 272 implants MBL in mm measured with oftware (Schick Technologies ) Intraoral Rx with parallelizer (parallel technique) Prosthetic rehabilitation (cemented or screwed) Implant length Implant diameter Postextraction implant or not Within 1 year after implant placement, bone loss was recorded as follows: the cement-retained group (CRG) showed mean bone levels of −1.23 ± 0.45 mm, and the screw-retained group (SRG) showed mean bone levels of −1.01 ± 0.33 mm. A slight increase appeared after a 3-year follow-up (0.30 ± 0.25 mm in CRG and 0.45 ± 0.29 mm in SRG). After that, marginal bone levels remained over time up to the 8-year follow-up. No statistically significant differences were found between groups (P > .05). Definitive cement- and screw-retained ceramic restorations are highly predictable, biocompatible and esthetically pleasing, and the two groups presented no statistically significant differences in bone loss. Simunek et al. 2010 Changes in stability after healing of immediately loaded dental implants. Int J Oral Maxillofac Implants. 2010 Nov- Dec;25(6):1085-92. Prospective 188 patients 940 implants MBL in mm (does not specify program used) OPG Moment of implant loading (immediate or deferred) Implant stability (insertion torque) Correlations between the MBL and the final insertion torque and between the MBL and the DISQ values were observed. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1065 Table 1 continue-15: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. den Hartog et al. 2017 Anterior single implants with different neck designs: 5 Year results of a randomized clinical trial. Clin Implant Dent Relat Res. 2017 Aug;19(4):717-724. Clinical trial 93 patients 93 implants MBL in mm measured with Adobe Photoshop (Adobe Photoshop CS3 Extended, Adobe Systems Inc., San Jose, California). Intraoral Rx with parallelizer (parallel technique) Implant location (I, C, PM, M) Implant diameter Prosthetic rehabilitation (cemented or screwed) Implant design No statistically significant differences were found between implants with a 1.5 mm smooth neck (“smooth group”), a rough neck with grooves (“rough group”) or a scalloped rough neck with grooves (“scalloped group”). Sayardoust et al. 2017 Clinical, radiological, and gene expression analyses in smokers and non-smokers, Part 2: RCT on the late healing phase of osseointegration. Clin Implant Dent Relat Res. 2017 Oct;19(5):901-915 Clinical trial 32 patients 92 implants MBL in mm (does not specify program used) with a magnification x7 Intraoral Rx with parallelizer (parallel technique) Smoking habit Bone quality and quantity Type of implant Implant location (maxilar, mandible) Smoking has an early effect on osseointegration, which is dependent on the implant surface properties and the local host response. Pessoa et al. 2017 Bone Remodeling Around Implants with External Hexagon and Morse-Taper Connections: A Randomized, Controlled, Split- Mouth, Clinical Trial. Clin Implant Dent Relat Res. 2017 Feb;19(1):97-110. Clinical trial 12 patients 24 implants MBL in mm measured with Image J, National Institutes of Health, Bethesda, MD, USA Intraoral Rx with parallelizer (parallel technique) Implant connection (external hexagonal or internal Morse) Gingival biotype Probing depth Radiographic peri-implant bone loss depends on the implant connection type. Morse-taper connections showed less peri-implant bone loss compared to external hexagon connections, but no statistically significant differences were found. Lee et al. 2010 A 3-year prospective radiographic evaluation of marginal bone level around different implant systems J Oral Rehabil. 2010 Jul;37(7):538-44. Prospective 54 patients 135 implants MBL in mm measured with UTHSCSA Image Too Intraoral Rx with parallelizer (parallel technique) Implant location (maxilar or mandible) Implant system Significant differences were noted in the MBL recorded for the three groups: rough-surface implants, a hybrid of smooth and rough-surface implants and rough surface with microthread implants (P < 0.0001). At 3 years, the rough surface with microthread implants had a mean crestal bone loss of 0.59 ± 0.30 mm; the rough-surface implants, 0.95 ± 0.27 mm and the hybrid surface implants, 1.05 ± 0.34 mm. Koutouzis et al. 2011 Retrospective evaluation of crestal bone changes around implants with reduced abutment diameter placed nonsubmerged and at subcrestal positions: the effect of bone grafting at implant placement. J Periodontol. 2011 Feb;82(2):234-42. Retrospective 100 patients 287 implants MBL in mm measured with DEXIS, Des Plaines, IL. Intraoral Rx with parallelizer (parallel technique) Bone regeneration or not Implant location (maxilar or mandible) There were no statistically significant differences between the subcrestally placed dental implants grafted with a xenograft and the subcrestally placed dental implants without any grafting material. They were reviewed regarding marginal peri-implant hard-tissue loss. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1066 Table 1 continue-16: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Nickenig et al. 2009 Radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced microthreaded implants using digitized panoramic radiographs. Clin Oral Implants Res. 2009 Jun;20(6):550-4 Prospective 34 patients 133 implants MBL in mm measured with Friacom Dental Office Software 2.4, Friatec AG, Mannheim, Germany OPG Implant design The machined-neck group had a mean crestal bone loss of 0.5 mm (range: 0 to 2.3) after the healing period, 0.8 mm after 6 months (range: 0 to 2.4) and 1.1 mm (range: 0 to 3) at the end of the followup. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (range: −0.4 to 2) after the healing period, 0.4 mm (range: 0 to 2.1) after 6 months and 0.5 mm (range: 0 to 2.1) at the end of the follow-up. The two implant types showed significant differences in marginal bone levels (healing period: P = 0.01; end of follow-up: P < 0.01). Vigolo et al. 2010 Clinical evaluation of marginal bone level change of multiple adjacent implants restored with splinted and nonsplinted restorations: a 5-year prospective study. Int J Oral Maxillofac Implants. 2010 Nov- Dec;25(6):1189-94. Prospective 44 patients 132 implants MBL in mm (does not specify program used) with a magnification x6 Intraoral Rx with parallelizer (parallel technique) Implant length Bone quality Prosthetic rehabilitation (splinted or not) The mean marginal bone level changes at the 5-year recall were −0.7 ± 0.2 mm for splinted restorations and −0.8 ± 0.2 mm) for nonsplinted restorations. The peri-implant MBL around nonsplinted implants in the present study was statistically equivalent to that observed in splinted implants. Barone et al. 2012 A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. J Periodontol. 2012 Jul;83(7):836-46. Clinical trial 40 patients 40 implants MBL in mm measured with UTHSCSA Image Tool, v.3.0, University of Texas Health Science Center, San Antonio, TX Intraoral Rx with parallelizer (parallel technique) Implant length Implant diameter Postextraction implants with regeneration or not No statistical differences were found between the grafted extraction sockets compared to implants placed into non-grafted sites in terms of implant survival and MBL. Sakka et al. 2013 Investigation of the effect of ibuprofen on the healing of osseointegrated oral implants. J Investig Clin Dent. 2013 May;4(2):113-9 Clinical trial 28 patients 57 implants MBL in mm manually measured with magnification x8 Intraoral Rx with parallelizer (parallel technique) Ibuprofen intake or not after surgery There were no significant differences between the ibuprofen and no-ibuprofen groups when comparing bone changes. Zuffetti et al. 2015 The topical administration of bisphosphonates in implant surgery: a randomized split-mouth prospective study with a follow-up up to 5 years. Clin Implant Dent Relat Res. 2015 Jan;17 Suppl 1:e168-76. Prospective 39 patients 155 implants MBL in mm measured with ImageJ version 1.46, National Institutes of Health, Bethesda, MD, USA; Intraoral Rx with parallelizer (parallel technique) Topical biphosphonate during surgery or not Implant length Type of edentulism (total or partial) The mean MBL was 0.85 ± 0.71 mm in the TG (a 3% clodronate solution mixed with the surfactant Tween-20 at a 1:3 ratio topically administered at the implant surface and at the implant site) and 1.12 ± 0.85 mm in the CG (a conventional insertion) after 1 year of loading and was stable thereafter. The difference was not significant. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1067 Table 1 continue-17: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Alissa et al. 2009 Influence of ibuprofen on bone healing around dental implants: a randomised double-blind placebo-con- trolled clinical study. Eur J Oral Implantol. 2009 Autumn;2(3):185-99. Clinical trial 61 patients 132 implants MBL in mm manual measured magnificacionx8, MAG 6, Pyser-SGI, Kent, UK Intraoral Rx with parallelizer (parallel technique) Ibuprofen intake or not after surgery Implant location (maxilar vs. mandible) For the mean marginal bone level changes at 3 months (P = 0.27) and at 6 months (P = 0.97), there were no statistically significant differences between a short course of systemic ibuprofen for postoperative pain management subsequent to implant placement and a placebo. Lago et al. 2018 Crestal Bone Level Around Tissue-Level Implants Restored with Platform Matching and Bone-Level Implants Restored with Platform-switching: A 5-Year Randomized Controlled Trial. Int J Oral Maxillofac Implants. 2018 Mar/Apr;33(2):448-456. Clinical trial 100 patients 202 implants MBL in mm measured with ImageJ (Wayne Rasband, National Institutes of Health ) Intraoral Rx with parallelizer (parallel technique) Type of implants (tissue level vs. bone level) Implant length Implant diameter The mean difference between the tissuelevel implants restored with platform matching and the bone-level implants restored with platform-switching was 0.31 mm at the baseline to 1 year, 0.53 mm at 1 to 5 years and 0.85 mm at the baseline to 5 years. There was a statistically significant difference in the MBL (P < .001). Derks et al. 2016 Peri-implantitis - onset and pattern of progression. J Clin Periodontol. 2016 Apr;43(4):383-8 Retrospective 427 patients 596 implants MBL in mm (does not specify program used) Does not specify the radiographic method used Progression pattern of peri-implantitis in implants with moderate to severe periimpantitis from 1 to 9 years A total of 70% and 81% of subjects presented with ≥ 1 implant with a bone loss of > 0.5 mm at 2 and 3 years, respectively. Peri-implantitis progresses in a nonlinear, accelerating pattern and, for the majority of cases, the onset occurs within 3 years of functioning (p < 0.0001). Esposito et al. 2016 Dental implants with internal versus external connections: 5-year post-loading results from a pragmatic multicenter randomised controlled trial. Eur J Oral Implantol. 2016;9 Suppl 1(2):129-41. Clinical trial 120 patients 203 implants MBL in mm (does not specify program used) Intraoral Rx (parallel technique) Implant connection MBL Five years after loading, there were no statistically significant differences in marginal bone level estimates between the internal and external connections (difference = 0.14 mm, 95% CI: −0.28 to 0.56, P (ancova) = 0.505), and both groups had statistically significant bone loss from implant placement: 1.13 mm for the external connection implants and 1.21 mm for the internal connection implants. Gamper et al. 2017 Randomized controlled clinical trial comparing one-piece and two-piece dental implants supporting fixed and removable dental prostheses: 4- to 6-year observations. Clin Oral Implants Res. 2017 Dec;28(12):1553-1559. doi: 10.1111/clr.13025. Epub 2017 May 29. Clinical trial 60 patients 151 implants MBL in mm measured with ImageJ, National Institutes of Health, Bethesda, Maryland USA Intraoral Rx (parallel technique) Implant design (implant and abutment one piece or not) Bone regeneration or not Prosthetic rehabilitation The median marginal bone level for the one-piece implant system group changed from 0.51 mm at the baseline to 0.49 mm. The two-piece implant system changed from 1.02 mm to 1.35 mm (P < 0.001) from the 4- to 6-year follow-up. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1068 Table 1 continue-18: Studies included after the research “marginal bone loss and peri-implantitis” and mar-ginal bone loss and dental implant. Sahrmann et al. 2016 Success of 6-mm Implants with Single-Tooth Restorations: A 3-year Randomized Controlled Clinical Trial. J Dent Res. 2016 Jun;95(6):623-8 Clinical trial 172 implants MBL in mm measured with ImageJ, (Image J64; National Institutes of Health, Bethesda, MD, USA) Intraoral Rx (parallel technique) Implant length We found no significant change in the crestal bone level from the baseline to 3 years for 6-mm or 10-mm implants. The changes were −0.19 ± 0.62 mm and −0.33 ± 0.71 mm, respectively. The intergroup difference was not significant. Kütan et al. 2015 Clinical and Radiographic Evaluation of Marginal Bone Changes around Platform-Switching Implants Placed in Crestal or Subcrestal Positions: A Randomized Controlled Clinical Trial. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e364-75 Clinical trial 28 patients 56 implants MBL in mm (does not specify program used) Intraoral Rx (parallel technique) Implant location (crestal or subcrestal) After 3 years, the mean radiographic vertical bone loss for the control bone-level group was significantly lower than in the below bone-level group (0.56 ± 0.35 mm and 1.21 ± 1.05 mm, respectively) (p < .01). Guljé et al. 2014 Single crowns in the resorbed posterior maxilla supported by either 6-mm implants or by 11-mm implants combined with sinus floor elevation surgery: a 1-year randomised controlled trial. Eur J Oral Implantol. 2014 Autumn;7(3):247-55. Clinical trial 41 patients 41 implants MBL in mm measured with Dicom- Works, Biomedical Engineering, University Medical Center Groningen, the Netherlands Intraoral Rx (parallel technique) Implant length Bone regeneration (maxillary sinus lift or not) No statistical differences were found between 6-mm implants and 11-mm implants combined with sinus floor elevation surgery to support a single crown in the resorbed posterior maxilla after a 1-year follow-up. Ravald et al. 2013 Long-term evaluation of Astra Tech and Brånemark implants in patients treated with full-arch bridges. Results after 12-15 years. Clin Oral Implants Res. 2013 Oct;24(10):1144-51 Clinical trial 66 patients 184 implants MBL in mm (does not specify program used) Intraoral Rx (parallel technique) Implant location (maxilar o mandible) Implant design Moment of implant loading (immediate or deferred) No statistically significant difference in implant loss or bone level change was found between Astra Tech TiOblast surfaces and Brånemark-turned implants. Gotfredsen et al. 2012 A 10-year prospective study of single tooth implants placed in the anterior maxilla. Clin Implant Dent Relat Res. 2012 Mar;14(1):80-7 Clinical trial 20 patients 20 implants MBL in mm was changed to Digora digital film (The Dental Imaging Company Ltd, Portslade, East Sussex, UK) Intraoral Rx (parallel technique) MBL Esthetic outcome The average marginal bone-level change was less than 1 mm, and there was no difference between early and delayed implant placement. J Clin Exp Dent. 2019;11(11):e1045-71. Marginal bone loss analysis e1069 Temmerman et al. 2017 (27) focused their study on postmenopausal women with osteoporosis/osteopenia, showing an MBL around implants of 0.01 ± 0.51 mm (Control Group [CG]: 0.05 ± 0.52 mm); the mean MBL from a subject was of 0.04 ± 0.27 mm (Osteoporosis/ Osteopenia Group: ˗0.17 ± 0.30 mm, CG: 0.04 ± 0.23 mm). They concluded that rehabilitation using implants in patients with osteoporosis can be carried out with the same success rate as in healthy patients. The stability analysis off dental implants can also be conditioned due to certain drugs that treat the patient’s underlying pathology and that alter bone remodeling immunity (28). Bisphosphonates are one such drug family that has been studied due to their ability to inhibit normal bone resorption, which entails a reduction in remodeling, for a higher bone density, better mineralization and a lower risk of bone fracture (29). Tallarico et al. 2016 (26) found that patients who were previously under bisphosphonate treatment had a 98.98% overall implant survival success rate and 100% prosthesis success rate. The mean MBL was 1.35 ± 0.21 mm (95% CI 1.24-1.38) at 3 years. Zuffetti et al. 2015 (30) obtained 100% survival rates in the implants for the experimental group; the implants for this group were topically rinsed with bisphosphonate before surgery implantation. The CG, on the other hand, had a 91.3% success rate; in this group, the implants were placed without applying the topical bisphosphonate rinse, and a significant difference was observed at 5 years (p < 0.01). The average MBL observed was 0.85 ± 0.71 mm in the experimental group and 1.12 ± 0.85 mm in the CG after one year of prosthetic loading; it then remained stable with no statistically significant differences. Thus, some authors suggested that implants coated with bisphosphonates allow the prolonged conservation of marginal bone. These authors observed that the implants coated with bisphosphonates show even less marginal bone resorption than the CG not coated with bisphosphonates, and a mean difference after 5 years of loading 0.34 mm (95% confidence interval 0.00-0.75 mm, p = 0.04) was observed (23). The medication prescribed after surgery must also be taken into account due to its possible effect on MBL, since several studies observed a greater MBL in patients who were administered ibuprofen after surgery, although their results were not statistically significant (20). -MBL Factors Related to Implant Design Dental implant surface is one of the factors more frequently analyzed, a greater crestal bone loss was observed in those implants with a mechanized surface (p = 0.01, end of follow-up: p < 0.01) (31). Among implants with a rough surface, those with coronal microtreatments have the lowest MBL compared with rough surface and hybrid implants (p < 0.05) (32, 33). Other authors agreed with these results, although they did not observe any statistically significant differences between the rough surface implants and the implants with mechanized coronal parts (34). However, the type of surface treatment used by different brands of implants with rough surfaces has been found to have lower MBL (p = 0.002) (35). However, they suggested that implants with a microtreatment in the crestal area of the implant may not have a positi- ve effect on implants located in the anterior maxilla and with relatively recent extractions (36). In addition to considering the surface of an implant, implant design has been studied, comparing cylindrical implants and conical implants; these studies have concluded that the implants with less highly polished surfaces and cylindrical shapes suffered less MBL per year in a statistically significant way (p < 0.05) (37). The extension of the spirals along the implant is another feature that has been studied and that shows a statistically significant difference in crestal bone loss, specifically between implants designed with spirals that run until the coronal part of the implant, which suffered a loss of 0.16 mm (SD 0.19 mm) after one year of functional loading compared to 0.30 mm (SD 0.22 mm) in the implants without spirals reaching the coronal part (38). Implant platform and connection type to the prosthetic abutment have also been shown to influence MBL. The implant abutment connection being located in the crestal area in straight implants and implants with platform-switching reflects greater marginal bone resorption, and the implants with platform change in infracrestal locations showed a significantly lower bone loss (8). This suggests that platform-switching can facilitate bone conservation at the crestal level (4). The implants with platform-switching and conical connection presented MBL that was significantly lower than implants with a standard platform (5). Some authors highlighted a slightly lower MBL in crestal implants compared with infracrestal implants (p < 0.01) (6). However, other authors did not obtain differences in the MBL of infracrestal implants with platform-switching in the maxilla and mandible (7). When analyzing the implant’s location with an internal conical connection screwed into an infracrestal and a crestal position and with respect to implants with a conical connection and a Morse-type internal seal in similar positions, no significant differences were observed, although the group with the crestal location and Morse-type connection presented the lowest MBL (8). The type of connection between dental implant and prosthetic rehabilitation has also been studied; some studies show that after one year of follow-up, there is significant MBL in implants with internal connection and in implants with external connection without a statistically significant difference existing between the type of connections (39). However, the results obtained in other studies highlight a greater MBL in external connection implants (40).