International Journal of Dental and Health Sciences Review Article Volume 02,Issue 06 6

EVALUATION OF CRESTAL BONE LOSS:A REVIEW UPDATE Yeshwante Babita1 ,Choudhary Neha2 ,Baig Nazish3 ,Gaurav Tated4, Kadam Pranit5 1.HOD, Dept of Prosthodontics,CSMSS Dental college,Aurangabad,Maharastra,India 2.MDS II, Dept of Prosthodontics,CSMSS Dental college,Aurangabad,Maharastra,India 3.Professor, Dept of Prosthodontics,CSMSS Dental college,Aurangabad,Maharastra,India 4.MDS II,Dept of Orthodontics, CSMSS Dental college,Aurangabad,Maharastra,India 5.MDS III, Dept of Prosthodontics,CSMSS Dental college,Aurangabad,Maharastra,India

ABSTRACT: The first report in the literature to quantify early crestal bone loss was a 15-year retrospective study that evaluated implants placed in edentulous jaws.In this study, Adell et al. reported an average of 1.2 mm marginal bone loss from the first thread during healing and the first year after loading. 200 articles were collected from google.out of the 200 articles 160 were eligible for the review.Out of the 160,107 are original.Out of this 107,62 were easily available and reviewed Keywords: crestal bone loss,evaluation,review

INTRODUCTION:

The first report in the literature to 200 articles were collected from quantify early crestal bone loss was a 15- google.out of the 200 articles 160 were year retrospective study that evaluated eligible for the review.Out of the implants placed in edentulous jaws.1In 160,107 are original.Out of this 107,62 this study, Adell et al. reported an average of 1.2 mm marginal bone loss were easily available and reviewed from the first thread during healing and FACTORS CAUSING CRESTAL BONE LOSS the first year after loading. In contrast [5] with the bone loss during the first year, TEMPERATURE there was an average of only 0.1 mm bone lost annually thereafter. Based on 1)Eriksson and Albrektsson reported that the findings on submerged the critical temperature for implant site implants,Albrektsson et al. and Smith preparation was 47°C for one minute or and Zarb proposed criteria for implant 40°C for seven minutes.[1] success, including a vertical bone loss of less than 0.2 mm annually following the 2)Matthews and Hirsch demonstrated implant’s first year of function. Non- that temperature elevation was submerged implants have also influenced more by the force demonstrated early crestal bone loss, appliedthan drill speed.10 When both with greater bone loss in the maxilla than in the mandible, ranging from 0.6 drill speed and applied force were to 1.1 mm, at the first year of function. increased, no significant increase in temperature was observed owing to METHOD efficient cutting.[2]

*Corresponding Author Address: DrNeha Choudhary Email: [email protected] Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 3)Sharawy et al. compared the heat Therefore, this hypothesis is not generated by the drills of four different generally supported. implant systems run at speeds of 1,225, 1,667 and 2,500 rpm.[] All of the drill Other Factors associated with increased systems were able to prepare an 8 mm bending overload in dental site without the temperature rising by implants:Prostheses supported by one or more than 4°C(to 41°C). For all drill two implants in the posterior region systems, the 1,225 rpm drill speed (Rangert et al. 1995);Straight alignment required a 30 to 40 % longer drilling time of implants; Significant deviation of the when compared with 2,500 rpm and a 20 implant axis from the line of action;High to 40 % reduction in the time required crown/implant ratio;Excessive cantilever for bone temperature to normalise. With length (>15 mm in the mandible, greater depth of preparation and Shackleton et al. 1994; >10–12 mm in insufficient time between drill changes, a the maxilla, Rangert et al. 1989; Taylor detrimental temperature rise to 47°C or 1991); Discrepancy in dimensions greater may be reached. The authors between the occlusal table and implant recommend that surgeons interrupt the head;Para-functional habits, heavy bite drilling cycle every five to ten seconds to force and excessive premature contacts allow irrigant time to cool the (>180 μm in monkey studies, Miyata et osteotomy. al. 2000; >100 μm in human studies, Falk et al. 1990);Steep cusp inclination;Poor PERIOSTEAL ELEVATION bone density/quality; and Inadequate number of implants. 4)The periosteal elevation has been suggested as one of the possible Based on a study by Frost, five types of contributing factors to crestal implant strain levels interrelated with different bone loss. Wilderman et al. reported load levels in the bone were described: that the mean horizontal bone loss after osseous surgery with periosteal 1) Disuse, bone resorption; elevation is approximately 0.8 mm, and 2) Physiological load, bone homeostasis; the reparative potential is highly dependent upon the amount of 3) Mild overload, bone mass increase; cancellous bone (not cortical bone) underneath the cortical bone.The bone 4) Pathological overload, irreversible loss at stage II implant surgery in bone damage;and successfully osseointegrated implants is 5) Fracture. generally vertical and noted only around the implant characterised by The concept of “microfracture” was saucerisation, not the surrounding bone proposed by Roberts et al., who even though during surgery all the bone concluded that crestal regions around was exposed. dental implants are high-stress-bearing 1574

Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 areas.[5]They explained that if the crestal connection was performed in the region is overloaded during bone submerged implant sites. At 6 months, all remodelling, “cervical cratering” is animals were sacrificed, and evaluations created around dental implants of the first bone-to-implant contact (fBIC), determined on standardized Peri-implantitis is one of the two main periapical radiographs, were compared to causative factors of implant failure in similar analyses made from later stages. A correlation between nondecalcified histology. It was shown plaque accumulation and progressive that both techniques provide the same bone loss around implants has been information (Pearson correlation reported in experimental studies and coefficient = 0.993; P < .001). The precision of the radiographs was within clinical studies. Tonetti and Schmid 0.1 mm of the histometry in 73.4% of the reported that peri-implant mucositis is a evaluations, while the level of agreement reversible inflammatory lesion confined fell to between 0.1 and 0.2 mm in 15.9% to peri-implant mucosal tissues without of the cases. These data demonstrate in bone loss. Peri-implantitis however an experimental study that standardized begins with bone loss around dental periapical radiography can evaluate implants. crestal bone levels around implants clinically accurately(within 0.2 mm) in a REVIEW OF LITERATURE high percentage (89%) of cases. These 1950s, Benkow suggested for the first findings are significant because crestal time the use of a beam-aiming device bone levels can be determined using a made up of a bite block connected to an noninvasive technique, and block indicator arm, which itself was attached sectioning or sacrifice of the animal to a beam-aiming ring. Thus, projection subject is not required. In addition, errors could be decreased to a significant longitudinal evaluations can be made extent[1] accurately such that bone changes over various time periods can be assessed. Larheim and Eggen showed for the first Such analyses may prove beneficial when time in implant dentistry that trying to distinguish physiologic changes standardized periapical radiography can from pathologic changes or when trying be significantly improved if a customized to determine causes and effects of bone bite record is additionally used in changes around dental implants.[3] combination with a bite block and a long- cone technique.[2] Tomas Albrektsson et al found Ten different studies of three modern implant Joachim S. Hermann et al placed Fifty- brands of moderately rough surfaces with nine implants in edentulous mandibular 10-year or longer follow-up times areas of 5 foxhounds in a side-by-side through a PubMed and manual search.It comparison in both submerged and was concluded that nonsubmerged techniques. Three months or probing depths are weak indicators of after implant placement, abutment crestal bone loss (CBL); that CBL occurs

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Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 for many other reasons than infection; factors influencing the long term success that implant-, clinician-, and patient- of the implant.[5] related factors contribute to CBL; and that modern oral implants outperform Summer introduced the osteotome older devices. Based on a literature technique in 1994. It has been claimed search, the frequency of implants with that using bone condensing to prepare the reported peri-implant infection and implant site in soft maxillary bone avoids significant bone loss leading to implant the risk of heat generation, and implants removal or other surgical intervention can be placed precisely with increased was on average 2.7% during 7 to 16 years primary stability. The purpose of this of function. The summed frequency of clinical study was to evaluate the crestal peri-implantitis and implant failure is bone loss exhibited by the bone around commonly less than 5% over 10 years of early nonfunctionally loaded implants follow-up for modern implants when placed with conventional implant using established protocols.[4] placement technique and with Summer’s osteotome technique and to evaluate Montaser n al-qutub evaluated the whether the bone-compression technique alveolar crestal bone loss around dental provides better primary stability than the implants with various diameters. A total conventional technique. A total of 10 of 120 patients (70 male and 50 female) Uniti implants were placed in the with 150 single Nobel Replace®Select maxillary anterior region of 5 patients. Tapered of different width were included One implant site was prepared using the in this study. The implants of size conventional technique with drills 3.5mmX10mm, 4.3mmX10mm, (controlgroup A), and second site was 5mmX10mm were used in this study. For prepared using the osteotome technique each implant, radiographic measurements (experimental group B) and anMIS bone of the marginal bone height and its compression kit. Resonance frequency change over time were made. Intraoral measurements (RFMs) weremade on radiographic examinations of all implants each implant at the time of fixture were performed at baseline, using placement and on the 180th day after paralleling technique and was compared implant fixture placement. The peri- to those taken at various subsequent post- implant alveolar bone loss was evaluated placement times at the end of 1st year, radiographically. Differences between 2nd year and 3rd year follow-ups to the alveolar crest and the implant evaluate crestal bone level changes. The shoulder in radiographs were obtained regular neck and wide neck implants immediately after implant insertion and showed relatively higher crestal bone loss on the 180th day after implant placement. compared to the narrow neck implants. The RFMs demonstrated a significantly All the three groups showed a higher stability of implants in control progressive increase in bone loss from group A than in experimental group B on first year to the 3rd year after implant the day of surgery (P 5 .026). However, placement. It can be concluded that no statistically significant difference in implant dimension might be one of the stability was found between both groups

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Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 on 180th day after implant placement of the implant, no correlation was found (P5.076). A significant difference was between MBL and the implant stability found in the crestal bone levels after 180 values (PerioTest), dimensions, site of days of surgery between two groups insertion or any of the other collected (P50) with less crestal bone loss with variables.Implants with a roughened neck group A. Within the limitations of this surface and microthreads are more study we concluded that the osteotome resistant to MBL during the first phases technique is good for the purpose of healing, as compared with implants forwhich itwas introduced, that is, for with a polished neck.[7] knife-edge ridges, and it should not be considered a substitute for conventional Records of 50 consecutive patients procedures for implant placement.[6] treated with subcrestally placed by Theofilos Koutouzis by dental implants Emanuel A. Bratu et al conducted an grafted with a xenograft (Group A) and intra-individual controlled clinical trial to 50 consecutive patients with subcrestally evaluate and compare the amount of placed dental implants without any marginal bone loss (MBL) found around grafting material (Group B) were implants of a comparable design, with or reviewed. For each implant, the without retention grooves (microthreads) radiographs after placement were or polished necks, during the early stages compared to images from the last follow- of healing.Materials and methods: Forty- up visit and evaluated regarding the eight (48) patients with missing following: 1) degree of subcrestal mandibular posterior teeth were treated positioning of the implant, 2) changes with two commercially available ofmarginal hard-tissue height over time, implants of the same brand (MIS): one and 3) whether marginal hard-tissue with microthreads (S-model) and the could bedetected on the implant platform other with a polished neck (L-model). at the follow-up visit. The mean marginal MBL around each implant was measured loss of hard tissues was 0.11 –0.30 mm on follow-up radiograms taken 4 months for Group A and 0.08 – 0.22 mm for after placement (exposure and crown Group B. Sixtynine percent of the cementation), and 6 and 12 months after implants in GroupAand 77% of the loading. Forty-six (46) patients implants in Group B demonstrated hard completed the study, making 46 implant tissue on the implant platform.There pairs available for statistical analysis. were no statistically significant None of the implants failed to integrate. differences between the groups regarding All the implants displayed some extent of marginal peri-implant hard-tissue loss. bone loss throughout the follow-up period. At each time point (exposure, 6 The present study fails to demonstrate and 12 months after loading), the S- that grafting of the remaining osseous model implants displayed statistically wound defect between the bone crest and significant lower amounts of bone loss the coronal aspect of the implant has a (0.22 vs. 0.76, 0.57 vs. 1.22 and 0.9 vs. positiveMeffect on marginal peri-implant [8] 1.5mm, respectively). Other than the type hard-tissue changes.

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Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 Following loading, using OPG and IOPA radiographs 06 and marginal bone loss after one year must be 12 months after implant placement. One evaluated AJ. Flichy-Fernández et al by implant failed in immediate loading to check correct maintenance of the bone group (Group A), whereas all implants levels.To assess implant treatment survived in conventional loading group success and quantify marginal bone loss (Group B). The average periimplant bone 6 and 12 months after loading. Sixty-one loss after 6 months and 1 year for Group MIS® implants with a 1.8 mm machined A were 0.69 mm and 1.09mm neck were placed in 26 patients. Implant respectively, whereas it was 0.74 mm and success was based on the criteria of 1.13mm respectively for Group B. The Buser. Radiological controls were made difference in the bone loss betweenGroup 6 and 12 months after loading, measuring A and B was not statistically significant. bone loss mesial and distal.Twenty-two Immediate implant loading protocol has a patients with 56 implants were included: highly acceptable clinical success rate in 32 in the maxilla and 24 in the mandible. partially edentulous lower jaw although Two implants failed in two patients implant survival rate is slightly inferior to during the phase (both conventional loading protocol.[10] in the maxilla), yielding an implant success rate of 96.4%. After 6 months, Ji-Hoon Park1 et a al conduacted this bone loss was 0.80±1.04 mm mesial and research to determine whether peri- 0.73±1.08 mm distal, while after 12 implant crestal bone loss could be months bone loss was 0.92±1.02 mesial affected by systemic disease, primary and 0.87±1.01 distal. Bone loss 6 and 12 ISQ value, implantation method months after machined neck implant (submerged vs. non-submerged), surface placement was within the normal ranges treatment, and bone density. Patients who described in the literature.[9] underwent fixture installation from June 24, 2005 to October 23, 2008 at Seoul The aim of Maj Guruprasada study is to National University Bundang Hospital evaluate andmcompare the effectiveness were evaluated. A total of 157 patients of immediate implant loading protocol (male: 52, female: 85) had 346 fixtures over conventional implant loading installed. Among them, 49 patients had protocol in partially edentulous mandible. periapical radiographs taken 1 year after Twenty patients were selected from out prostheses were first set. A total of 97 patients department who needed the fixtures were implanted. In particular, 30 replacement of one of the missing fixtures were installed in patients with mandibular first molar. They were systemic diseases such as diabetes divided into two groups. In Group A mellitus, cardiovascular disease, patients implants were loaded with hypertension, and liver disease. The immediate implant loading protocol, immediate stability of implants was whereas in Group B they were loaded measured with Osstelltm. Implant surface with conventional loading protocol. treatment was classified into two groups Periimplant bone loss and soft tissue (RBM, Cellnest (Anodized)), and bone health were measured and compared density, into four groups (D1~D4). The

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Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 bone resorption on the mesial and distal submerged) with regard to the amount of areas of fixtures was measured with alveolar bone loss 1 year after prostheses periapical radiographs using the were first set (p<0.05). Non-submerged paralleling technique, and the mean value implants showed less crestal bone loss. was calculated. The length determination Note, however, that other variables had program in IMPAX (AGFA, Belgium) no correlation with crestal bone loss was used.At least 332 out of 346 (96%) (p>0.05).There was a statistically installed GS implants were successfully significant difference between the 1-stage osseointegrated 1 year after prostheses method and 2-stage methodwith regard to were first set. The mean value of the the amount of alveolar bone loss 1 year bone resorption of the installed GS after prostheses were first set. Systemic implants was 0.44mm. The minimum disease, primary ISQ value, surface value was 0mm, and the maximum value, treatment, and bone density were not 2.85mm. There was a statistically associated with alveolar bone loss. Other significant difference between the variables were assumed to have a implantation methods (submerged, non- correlation with alveolar bone loss.[11]

REFERENCES:

1. Benkow HH. Periodisk-identiske og 5. Montaser n al-qutub, Radiologic stereoskopiske intraorale evaluation of the marginal bone loss røntgenopptak. Den Norske around dental implants with Tannlaegetidende 1956; 66:239–255 different neck diameters 2. Larheim TA, Eggen S. Measurements 6. Thallam Veer Padmanabhan,Rajiv of alveolar bone height at tooth and KumarComparison of Crestal Bone implant abutments on intraoral Loss and Implant Stability Among radiographs.A comparison of the ImplantsPlaced With reproducibility of Eggen technique Conventional Procedure and Using utilized with and without a bite Osteotome Technique:A Clinical impression. J Clin Periodontol Study DOI: 10.1563/AAID-JOI-D-09- 1982;9:184–192. 00049 3. Joachim S. Hermann,John D. 7. Emanuel A. Bratun Moshik Schoolfield, Pirkka V. Nummikoski, Tandlichn Lior Shapira ; A rough Crestal Bone Changes Around surface implant neck with Titanium Implants: A Methodologic microthreads reduces the amount of Study Comparing Linear marginal bone loss: a prospective Radiographic with Histometric clinical study Clin. Oral Impl. Res. Measurements Volume 16, Number 20, 2009 / 827–832 4, 2001;475-485 8. Theofilos Koutouzis, Michael 4. Tomas Albrektsson, Daniel Buser, Fetner, Alan Fetner, Tord Lundgren Lars Sennerby Crestal Bone Loss ;Retrospective Evaluation of Crestal and Oral Implants Clinical Implant Bone Changes Around Implants Dentistry and Related Research, With Reduced Abutment Diameter Volume 14, Number 6, 2012 Placed Non-Submerged and at

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Choudhary N.et al, Int J Dent Health Sci 2015; 2(6):1573-1580 Subcrestal Positions: The Effect of bone levels of immediate and at Implant Placement. conventionally loaded implants J Periodontol 2011;82:234-242. medical journal armed forces india 9. AJ. Flichy-Fernández , J. Ata-Ali , C. 69 ( 2013 ) 41 e4 7 Palma-Carrió , D. Peñarrocha-Oltra , 11. Ji-Hoon Park1, Young-Kyun Kim1, J. Conejero 3, M. Peñarrocha Pil-Young Yun1, Analysis of factors Radiological assessment of peri- affecting crestal boneloss around implant bone loss a 12-month the implants J Kor Dent Sci. 2009; 3(1) : -12- retrospective study. J Clin Exp Dent. 17 2011;3(5):e430-4. 10. Maj Guruprasada , Maj Gen G.K. Thapliyal , Brig V.R. Pawar A comparative analysis of periimplant

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