Prosthetic Design and Occlusal Load

It has been postulated that mechanical overloading is a contributing factor to many instances of peri-implant bone loss and late implant failures.76 Occlusal load is influenced by prosthetic design but hard to study due to lack of quantification of overload. Some studies indicate that micromotion at the implant-abutment interface compromises the establishment of implant osseointegration during early healing77 and that implants that have off-axis forces, such as a cantilever design demonstrate more peri-implant bone loss after loading.76,77 Despite being difficult to quantify occlusal overload in the literature, a systematic review concluded that occlusal overloading was associated with peri-implant marginal bone loss caused by microtrauma concentrated at the marginal bone.78 It follows that prosthetically-driven and biologically executed treatment planning as well as assessment of occlusal load, including inspection of implant prostheses for signs of potential grinding and other parafunctional habits and occlusal adjustment or prosthetic replacement when premature contacts or interferences are present should be undertaken during the maintenance phase to insure optimal dental implant health.31

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