Effect of Early Radiographic Bone Loss Before Loading on Implant-Related Outcomes: A Long-Term Retrospective Study

This retrospective study primarily evaluated whether early radiographic bone loss (ERBL) predicts progressive bone loss (PBL), and secondarily assessed its association with implant survival and peri-implant diseases.

Adults with dental implants who were followed for at least 5 years were included. Implants presenting ERBL, defined as apical migration of the interproximal marginal bone involving exposure of the implant rough surface before insertion of the final prosthesis, were classified as ERBL+; non-exposure group was defined as implants without evidence of ERBL (ERBL-). Regression analyses were performed to evaluate associations with PBL.

A total of 261 implants, 87 ERBL+, and 174 ERBL- were included. [Correction added on 8 March 2026, after first publication: The preceding sentence has been corrected.] Mean follow-up periods were 8.8 ± 3.0 years for the ERBL+ and 11.5 ± 1.7 years for the ERBL-. ERBL+ exhibited significantly greater PBL than ERBL- (-1.6 ± 1.0 mm to -2.3 ± 1.7 mm vs. -0.4 ± 1.2 mm to -0.5 ± 1.2 mm; p < 0.001). Implant survival was lower in ERBL+ (67.8%) compared with ERBL- (98.3%; p < 0.001). Peri-implantitis was diagnosed in 63.2% of implants in the ERBL+ group versus 5.2% in ERBL- (p < 0.001), and 68.4% of patients versus 6.1% of ERBL- (p < 0.001). [Correction added on 8 March 2026, after first publication: The preceding sentence has been corrected.] ERBL was the strongest predictor of greater PBL (+1.46 mm; p < 0.0001). Male sex (+0.40 mm; p = 0.02), smoking (+0.61 mm; p = 0.004), each additional implant (+0.17 mm; p < 0.0001), single-crown restorations (+0.66 mm; p = 0.005), and bone-level implants (+0.32 mm; p = 0.005) were associated with increased PBL.

ERBL is a strong predictor of PBL and is associated with a higher risk of implant loss and peri-implantitis onset.