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Terzioglu B, Ayyildiz BG. Effect of supracrestal tissue height on marginal bone level changes at platform-switching dental implants placed crestally and subcrestally: A randomized clinical-trial. J Dent 2024; 148:105219. [PMID: 38960001 DOI: 10.1016/j.jdent.2024.105219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES The presence of insufficient peri-implant supracrestal tissue height (STH) may increase marginal bone resorption. This study aims to evaluate the effect of STH on marginal bone level changes (ΔMBC) in platform-switching posterior implants placed crestally and subcrestally. METHODS A total of 80 implants were included in this study. There were two main groups in the study; STH≤2 mm (A) and STH> 2 mm (B) and four subgroups according to the implant placement level, crestally (I) and subcrestally (II): A-I, A-II, B-I, and B-II. Intraoperatively, STH and placement depths of implants were measured from mesial and distal aspects. The mesial and distal peri-implant marginal bone levels were measured on periapical radiographs at immediately (T0), 6 months (T1), 9 months (T2), and 12 months (T3) after functional loading, and the difference between the marginal bone levels was calculated as the ΔMBC. RESULTS Statistically significantly more mesial ΔMBC was detected in the A-I than in the B-I at the time of T0-T1. In the group with STH greater than 2 mm, the difference in ΔMBC between the crestally and subcrestally placements was not statistically significant. CONCLUSIONS This study was found that STH is effective at protecting the marginal bone in the early period, and in cases where the STH is insufficient, subcrestally placement may increase long-term implant success by preventing marginal bone loss from occurring beyond the implant shoulder. The clinical trial number is NCT05595746. CLINICAL SIGNIFICANCE In this study, it was demonstrated that an STH greater than 2 mm is important for marginal bone stabilization, regardless of crestal and subcrestal levels, and that subcrestally placement is beneficial in cases of insufficient STH.
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Affiliation(s)
- Busra Terzioglu
- Kutahya Health Sciences University, Tavsanli Vocational School of Health Services, Kutahya, Turkey; Kutahya Health Sciences University, Faculty of Dentistry, Department of Periodontology, Kutahya, Turkey.
| | - Berceste Guler Ayyildiz
- Kutahya Health Sciences University, Faculty of Dentistry, Department of Periodontology, Kutahya, Turkey.
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Vilela N, Gurgel BCV, Bruzos CD, Duarte WR, da Silva HDP, Pannuti CM, Duarte PM. Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors. J Periodontol 2024. [PMID: 38923568 DOI: 10.1002/jper.24-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL. METHODS This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm. RESULTS A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84). CONCLUSION The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor.
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Affiliation(s)
- Nathalia Vilela
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Bruno C V Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Carlos De Bruzos
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Wagner R Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Hélio D P da Silva
- Department of Dentistry, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Claudio M Pannuti
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Comuzzi L, Ceddia M, Di Pietro N, Inchingolo F, Inchingolo AM, Romasco T, Tumedei M, Specchiulli A, Piattelli A, Trentadue B. Crestal and Subcrestal Placement of Morse Cone Implant-Abutment Connection Implants: An In Vitro Finite Element Analysis (FEA) Study. Biomedicines 2023; 11:3077. [PMID: 38002077 PMCID: PMC10669349 DOI: 10.3390/biomedicines11113077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The issue of dental implant placement relative to the alveolar crest, whether in supracrestal, equicrestal, or subcrestal positions, remains highly controversial, leading to conflicting data in various studies. Three-dimensional (3D) Finite Element Analysis (FEA) can offer insights into the biomechanical aspects of dental implants and the surrounding bone. A 3D model of the jaw was generated using computed tomography (CT) scans, considering a cortical thickness of 1.5 mm. Subsequently, Morse cone implant-abutment connection implants were virtually positioned at the model's center, at equicrestal (0 mm) and subcrestal levels (-1 mm and -2 mm). The findings indicated the highest stress within the cortical bone around the equicrestally placed implant, the lowest stress in the -2 mm subcrestally placed implant, and intermediate stresses in the -1 mm subcrestally placed implant. In terms of clinical relevance, this study suggested that subcrestal placement of a Morse cone implant-abutment connection (ranging between -1 and -2 mm) could be recommended to reduce peri-implant bone resorption and achieve longer-term implant success.
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Affiliation(s)
- Luca Comuzzi
- Independent Researcher, San Vendemiano-Conegliano, 31020 Treviso, Italy;
| | - Mario Ceddia
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, 70125 Bari, Italy; (M.C.); (B.T.)
| | - Natalia Di Pietro
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.I.); (A.M.I.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.I.); (A.M.I.)
| | - Tea Romasco
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Margherita Tumedei
- Department of Medical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
| | - Alessandro Specchiulli
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, 70125 Bari, Italy; (M.C.); (B.T.)
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Fernández-Figares-Conde I, Castellanos-Cosano L, Fernandez-Ruiz JA, Soriano-Santamaria I, Hueto-Madrid JA, Gómez-Lagunas J, Romano-Laureato R, Torres-Lagares D. Multicentre Prospective Study Analysing Relevant Factors Related to Marginal Bone Loss: A Two-Year Evolution. Dent J (Basel) 2023; 11:185. [PMID: 37623281 PMCID: PMC10453256 DOI: 10.3390/dj11080185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The aim of this prospective descriptive study was to analyse the possible variables associated with marginal bone loss in rehabilitated implants (Proclinic S.A.U, Zaragoza, Spain) two years after their prosthetic loading. MATERIALS AND METHODS Three clinical centres collaborated for a period of two years after the prosthetic rehabilitation of the implants (Proclinic S.A.U, Zaragoza, Spain), in which marginal bone loss and the possible associated variables were evaluated. The collection form comprised different variables throughout different stages of the implant procedure, from implant insertion to the subsequent prosthetic rehabilitation, over a two-year period. Data of the patients and implant characteristics were studied. Statistical analysis was performed with SPSS for qualitative (univariate logistic regressions, Chi2 test, and Haberman's corrected standardised residuals) and quantitative variables (Kolmogorov-Smirnov test). RESULTS The total study sample consisted of 218 implants (Proclinic S.A.U, Zaragoza, Spain). The sample presented a frequency of 99 men (45.4%) and 119 women (54.6%). The mean age of the patients among the reported cases was 58.56 ± 10.12 years. A statistically significant association was found between marginal bone loss 2 years after prosthetic rehabilitation placement and several variables, including age (under 55 years, 0.25 mm ± 0.56; 55-64 years, 0.74 mm ± 0.57; over 65 years, 0.63 mm ± 0.55; p < 0.0001), gender (female, 0.74 mm ± 0.61; male, 0.34 mm ± 0.51; p < 0.0001), bone quality (D1, 0.75 mm ± 0.62; D2, 0.43 mm ± 0.57; D3, 0.65 mm ± 0.60; p < 0.01), implant diameter (up to 4 mm, 0.49 mm ± 0.58; more than 4 mm, 1.21 mm ± 0.30; p < 0.0001), prosthetic connection type (direct to implant, 0.11 mm ± 0.58; transepithelial straight, 0.67 mm ± 0.57; transepithelial angled, 0.33 mm ± 0.25; p < 0001), implant model (internal conical, 0.17 mm ± 0.24; external conical, 0.48 mm ± 0.61; external cylindrical, 1.12 mm ± 0.32; p < 0.0001), prosthetic restoration type (full denture, 0.59 mm ± 0.59; partial denture, 0.50 mm ± 0.85; unitary crown, 0.08 mm ± 0.19; p < 0.05), and insertion torque (>35 N/cm, 0.53 mm ± 0.58; <35 N/cm, 1.04 mm ± 0.63; p < 0.01). CONCLUSIONS At 2 years, marginal bone loss following prosthetic rehabilitation was shown to be influenced by multiple factors. Correct implantological planning is of vital importance for successful rehabilitation.
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Affiliation(s)
| | - Lizett Castellanos-Cosano
- Department of Stomatology, School of Dentistry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
| | | | | | - Juan-Antonio Hueto-Madrid
- Independent Researcher, Pg. de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (J.-A.H.-M.); (J.G.-L.)
| | - Javier Gómez-Lagunas
- Independent Researcher, Pg. de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (J.-A.H.-M.); (J.G.-L.)
| | | | - Daniel Torres-Lagares
- Department of Stomatology, School of Dentistry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
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Li R, Wu Z, Chen S, Li X, Wan Q, Xie G, Pei X. Biomechanical behavior analysis of four types of short implants with different placement depths using the finite element method. J Prosthet Dent 2023; 129:447.e1-447.e10. [PMID: 36737356 DOI: 10.1016/j.prosdent.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
STATEMENT OF PROBLEM The clinical application of short implants has been increasing. However, studies on the marginal bone loss of short implants are sparse, and clinicians often choose short implants based on their own experience rather than on scientific information. PURPOSE The purpose of this finite element analysis study was to evaluate the microstrain-stress distribution in the peri-implant bone and implant components for 4 types of short implants at different placement depths of platform switching. MATERIAL AND METHODS By using short implants as prototypes, 4 short implant models were 1:1 modeled. The diameter and length of the implants were 5×5, 5×6, 6×5, and 6×6 mm. The restoration was identical for all implants. Three different depths of implant platform switching were set: equicrestal, 0.5-mm subcrestal, and 1-mm subcrestal. The models were then assembled and assigned an occlusal force of 200 N (vertical or 30-degree oblique). A finite element analysis was carried out to evaluate the maximum equivalent elastic strain and von Mises stress in the bone and the stress distribution in the implant components. RESULTS The 5×5 implant group showed the largest intraosseous strain (21.921×103 με). A 1-mm increase in implant diameter resulted in a 17.1% to 37.4% reduction in maximum intraosseous strain when loaded with oblique forces. The strain in the bone tended to be much smaller than the placement depth at the equicrestal and 0.5-mm subcrestal positions than that at the 1-mm subcrestal position, especially under oblique force loading, with an increase of approximately 37.4% to 81.8%. In addition, when the cortical bone thickness was less than 4 mm, 5×6 implants caused significantly higher intraosseous stresses than 6×6 implants. CONCLUSIONS Large implant diameters, rather than long implants, led to reduced intraosseous strain, especially under oblique loading. Regarding the implant platform switching depth, the short implant showed small intraosseous strains when the platform switching depth was equicrestal or 0.5-mm subcrestal.
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Affiliation(s)
- Ruyi Li
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Zhanglin Wu
- Graduate student, State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu, PR China
| | - Song Chen
- Resident, Stomaological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, PR China
| | - Xiang Li
- Undergraduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Qianbing Wan
- Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Guo Xie
- Associate Professor, State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu, PR China
| | - Xibo Pei
- Associate Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
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Wach T, Skorupska M, Trybek G. Are Torque-Induced Bone Texture Alterations Related to Early Marginal Jawbone Loss? J Clin Med 2022; 11:jcm11206158. [PMID: 36294479 PMCID: PMC9604800 DOI: 10.3390/jcm11206158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
The reason why marginal bone loss (MBL) occurs after dental implant insertion without loading has not yet been clearly investigated. There are publications that confirm or reject the notion that there are factors that induce marginal bone loss, but no research investigates what exactly occurs in the bone surrounding the implant neck. In this study, 2196 samples of dental implant neck bone radiographs were analyzed. The follow-up period was 3 months without functional loading of the implant. Marginal bone loss was evaluated in relation to the torque used during the final phase of implant insertion. Radiographic texture features were also analyzed and evaluated. The analyses were performed individually for the anterior and posterior part of the alveolar crest in both the mandible and maxilla. After 3 months, an MBL relation with higher torque (higher than 40 Ncm; p < 0.05) was observed, but only in the lower jaw. The texture features Sum Average (SumAverg), Entropy, Difference Entropy (DifEntr), Long-Run Emphasis (LngREmph), Short-Run Emphasis (ShrtREmph), and discrete wavelet decomposition transform features were changed over time. This study presents that MBL is related to the torque value during dental implant insertion and the location of the procedure. The increasing values of SumAverg and LngREmph correlated with MBL, which were 64.21 to 64.35 and 1.71 to 2.01, respectively. The decreasing values of Entr, DifEntr, and ShrtREmph also correlated with MBL, which were 2.58 to 2.47, 1.11 to 1.01, and 0.88 to 0.84, respectively. The analyzed texture features may become good indicators of MBL in digital dental surgery.
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Affiliation(s)
- Tomasz Wach
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Zeromskiego Str., 90-549 Lodz, Poland
- Correspondence: ; Tel.: +48-42-639-3422
| | - Małgorzata Skorupska
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Zeromskiego Str., 90-549 Lodz, Poland
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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Measures of Corticalization. J Clin Med 2022; 11:jcm11185463. [PMID: 36143109 PMCID: PMC9500652 DOI: 10.3390/jcm11185463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction.
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Kumar P, Dammani B, Mahajani MJ, Vadvadgi VH, Jawade R, Patil MV. A Two-Year Follow-Up Assessment of Decreasing Crestal Bone Levels Around Dental Implants in Patients Rehabilitated With Mandibular Implant Overdentures. Cureus 2022; 14:e29044. [PMID: 36237773 PMCID: PMC9553015 DOI: 10.7759/cureus.29044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 11/18/2022] Open
Abstract
Aim: This two-year follow-up study was aimed to evaluate declining crestal bone levels around dental implants in patients rehabilitated with mandibular implant-supported overdentures. A three-dimensional advanced radiographic tool, cone beam computed tomography (CBCT), was utilized as radiographic aid in this study. Materials & Methods: A total of 15 patients wearing mandibular implants supported overdentures were studied for two years. Randomization and strict inclusion/exclusion criteria were followed during study execution. Complete dentures were fabricated with standard methods, which were later anchored by a bilateral implant in the mandibular jaw. Bone loss at all four surfaces in all studied implants was estimated by the cone beam computed tomography (CBCT) technique. These assessments were done at postoperative follow-up periods of six, 12, 18, and 24 months. Duly signed and informed consent was obtained from all participating patients. Statistical Analysis and Results: The statistical analysis was completed by the software IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. All relevant data was entered into it to be analyzed with suitable statistical tests. Out of all 15 studied patients, 11 were male, and four were female. P-value was very significant for the age range 35-40 years (0.01). In all instances, the lingual surface showed minimum, while the distal surface showed maximum bone loss when seen at all postoperative phases. Grossly, the mean bone loss ranged between 0.14-0.45. P-value was highly significant for the measurements made at the lingual and distal sides of implants (for both B and D positions). A comparison of both study groups by one-way ANOVA confirmed a highly significant p-value for estimations done between the groups (0.001). Conclusion: Within the limitations of the study, the authors confirmed that crestal bone levels showed a clear decreasing pattern in the postoperative phases. Since these deleterious processes can compromise long-term prosthesis success, operators should consider all these facts while planning to implant an overdenture prosthesis in the lower jaw.
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