Observational studies have indicated that crestal bone level changes at implants are typically associated with clinical signs of inflammation, but still mechanical overload has been described as possible factor leading to hard–tissue deficiencies at implant sites without mucosal inflammation. The aim of this paper was systematically review the literature regarding the possible effect of traumatic occlusal forces on the peri-implant bone levels. Literature search was conducted using PubMed, Scielo and Lilacs, including the following terms: oral OR dental AND implant$ AND (load OR overload OR excessive load OR force$ OR bruxism) AND (bone loss OR bone resorption OR implant failure$). Databases were searched for the past 10 years of publications, including: clinical human studies, either randomized or not, cohort studies, case control studies, case series and animal research. Exclusion criteria were review articles, guidelines and in vitro and in silico (finite element analysis) research, as well as retrospective studies. The PICO questions formulated was: “does traumatic occlusal forces lead to peri-implant bone loss?” The database searches as well as additional hand searching, resulted in 807 potentially relevant titles. After inclusion/exclusion criteria assessment 2 clinical and 4 animal studies were considered relevant to the topic. The included animal studies did not reveal an association between overload and peri-implant bone loss when lower overloads were applied, whereas in the presence of excessive overload it seemed to generate peri-implant bone loss, even in the absence of inflammation. The effect of traumatic occlusal forces in peri-implant bone loss is poorly reported and provides little evidence to support a cause-and-effect relationship in humans, considering the strength of a clinically relevant traumatic occlusal force.

Camila Lima de Andrade, DDS, MSc, PhD/Marco Aur?lio Carvalho, DDS, MSc/Dimorvan Bordin, DDS, MSc/Wander Jos? da Silva, DDS, MSc, PhD/Altair Antoninha Del Bel Cury, DDS, MSc, PhD/Bruno Salles Sotto-Maior, DDS, MSc, PhD: Purpose: The aim of this study was to evaluate the influence of implant macrodesign when using different types of collar and thread designs on stress/strain distributions in a maxillary bone site. Materials and Methods: Six groups were obtained from the combination of two collar designs (smooth and microthread) and three thread shapes (square, trapezoidal, and triangular) in external hexagon implants (4 ? 10 mm) supporting a single zirconia crown in the maxillary first molar region. A 200-N axial occlusal load was applied to the crown, and measurements were made of the von Mises stress (σ_vM) for the implant, and tensile stress (σ_max), shear stress (τ_max), and strain (ε_max) for the surrounding bone using tridimensional finite element analysis. The main effects of each level of the two factors investigated (collar and thread designs) were evaluated by one-way analysis of variance (ANOVA) at a 5% significance level. Results: Collar design was the main factor of influence on von Mises stress in the implant and stresses/strain in the cortical bone, while thread design was the main factor of influence on stresses in the trabecular bone (P < .05). The optimal collar design able to produce more favorable stress/strain distribution was the microthreaded design for the cortical bone. For the trabecular bone, the triangular thread shape had the lowest stresses and strain values among the square and trapezoidal implants. Conclusion: Stress/strain distribution patterns were influenced by collar design in the implant and cortical bone, and by thread design in the trabecular bone. Microthreads and triangular thread-shape designs presented improved biomechanical behavior in posterior maxillary bone when compared with the smooth collar design and trapezoidal and square-shaped threads.