8 – The effect of loading on peri-implant bone: A critical review of the literature

TLDR: In this article, the authors assess the role of mechanical loading on the establishment and the maintenance of oral implant osseointegration and conclude that in case of an efficient force transfer between implant and surrounding tissues, mechanical loading might even stimulate peri-implant bone formation and therefore osseointment regeneration.

Abstract: In the 1990s, there was a general belief that mechanical overloading was one of the main reasons for late implant failure. This triggered research to assess the role of mechanical loading on the establishment and the maintenance of oral implant osseointegration. Animal experimental studies indeed suggested the potential detrimental effect of excessive mechanical load on peri-implant bone, although randomized or controlled clinical trials of treatment interventions of oral implants designed to study overload are lacking. The lack of quantification of so-called “overload” at the implant level in the intraoral setting is one of the main shortcomings in the literature. The level of evidence of the studies on bone response to implant loading is weak and does not indicate that overload can lead to peri-implant bone loss, except in the case of inflammation. Clinical and animal experimental studies on early and immediate implant loading, however, provide information on the impact of mechanical loading on the process of osseointegration. It is obvious that micromotion between the implant and host tissues compromises osseointegration. However, in case of an efficient force transfer between implant and surrounding tissues, mechanical loading might even stimulate peri-implant bone formation and therefore osseointegration.