Zero bone loss after implant placement
“Why should we settle for 40-year old implant success criteria?” Prof. Tomas Linkevičius | Lithuania Institute of Odontology, Faculty of Medicine, Vilnius University Interview conducted by Dr. Marjan Gilani
Is a couple of millimeters of bone remodeling around implants normal? Is this implant successful? Prof. Tomas Linkevičius believes that with the advance of science and biomaterials it is not too ambitious to expect no bone loss after implant placement.¹ Prof. Linkevičius, most clinicians believe that bone remodeling around implants is inevitable. Do you disagree? Prof. Linkevičius: Yes, I do. For many years we were trained that bone loss is inevitable. One of the most cited references in implant dentistry is from Albrektsson et al in which a few millimeters of bone remodeling around an implant is an expected physiological reaction and does not impair implant success.² In the past this was okay. But today, with all the new biomaterials, technology and knowledge, why settle for 40-year old implant success criteria? Would we expect the same for cancer treatment, stroke or heart attacks?
Believing that bone remodeling should stop after one year makes our job easier, but we can’t say for sure that it will actually stop. And a certain amount of bone remodeling makes these implants more susceptible to soft-tissue inflammation, peri-implantitis and other complications.
Advances in esthetic dentistry have brought more attention to soft tissue management. And, indeed, soft tissue is as important as bone for implant success – not only for esthetics but also function.
Can you give an example? Consider implant placement in the posterior region. Buccal bone resorption in this area is not a threat to implant stability. But it creates a defect in the soft tissue contour – a site prone to food collection that should be cleaned after each meal.
Should we shift our mindset to preventive considerations? What role does soft tissue management play?
One could say this is not a big deal, but why should patients live with this inconvenience, when, with proper soft tissue management, we can make the treated site easier to clean and more like natural teeth?
It’s an important paradigm shift. For many years bone was our main concern, but today patients have higher esthetic demands.
Patients don’t often complain. They think this is a normal condition with which they have to live. It’s our job to inform them
You advocate a “zero bone loss” approach? Yes. In some indications we might still lose some bone, but for most implants we can have zero bone loss after implant placement. We should raise the bar of our expectations and get rid of the old mindset. And this is what I teach in my online course.
“Soft tissue is as important as bone for implant success – not only for esthetics but also function.”
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