Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy · Private Practice, 37045 Terranegra di Legnago (VR), Italy · Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy · Private Practice, 41049 Sassuolo (MO), Italy
Initial bone remodeling (IBR) around dental implants is a multifactorial process influencing long-term success. While historical criteria allowed up to 2 mm marginal bone loss in the first year, recent evidence indicates that resorption >0.5 mm within 6–12 months significantly increases long-term peri-implantitis risk. IBR, defined as dimensional bone changes from implant placement through one year of loading, is non-infective in origin but may predispose to bacterial colonization if implant treated surface becomes exposed. Key anatomical determinants include bone density, crestal bone width, and supracrestal tissue height. High-density cortical bone, insufficient buccal/palatal bone envelope, or thin supracrestal mucosa correlate with greater marginal bone resorption. Implant characteristics such as internal conical connections, platform switching, optimized crest module geometry, and favorable transmucosal profiles can reduce microbial leakage, optimize load distribution, and promote long-term crestal bone stability. A critical surgical factor is apico-coronal placement of the implant according to mucosal vertical thickness, ensuring bone remodeling during supracrestal tissue adhesion occurs coronal to the platform. Depth varies with tissue phenotype and requires precise assessment. Additional measures include controlling intraosseous temperature and avoiding excessive insertion torque to limit cortical compression. In the prosthetic phase, risk factors include repeated abutment dis/reconnections, abutment height <2 mm in bone-level implants, excess cement, and excessively convex emergence profiles. Mitigation strategies involve “one abutment–one time” protocols or the use of tissue-level implants, screw-retained or cement-free retention, abutments >2 mm in height, and emergence profiles that promote soft tissue stability and facilitate plaque control. Integrating biology-driven site preparation, accurate apico-coronal positioning, selection of macro- and micro-designs with documented bone-preserving properties, and evidence-based prosthetic protocols can minimize IBR. This multidisciplinary approach shifts the objective from accepting early marginal bone loss to its prevention, improving the predictability, longevity, and biological stability of implant-supported rehabilitations.
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