Early implant bone loss: preventable or inevitable?

Early implant bone loss (EIBL) is defined as the periimplant crestal bone loss occurring from fixture installation to 1 year after loading. This phenomenon has been suggested to be associated with biologic and biomechanical factors. Minimizing EIBL at every treatment step is preferable because this may improve implant health, aesthetics, and overall success. This review presents the host-related factors, implant design characteristics, and the surgical and restorative protocol modifiers that should be evaluated during therapy. Host-related factors may involve the healing capacity, periodontal status, and occlusal function. Implant design features to be considered include the control of biologic width, microgap, and crestal stress distribution. Finally, surgical and restorative factors to be considered are implant site development, minimally invasive surgical approach, implant positioning, and the restorative design and occlusal scheme. Rationale and strategies to control the modifiable factors are also proposed.