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Stress and Inflammation as a Detrimental Combination for Peri-implant Bone Loss

¹ School of Dental Medicine, University of Erlangen-Nuremberg, Glückstr. 11, 91054 Erlangen, Germany;
² Institute of Applied Mathematics, University of Erlangen-Nuremberg, Germany;
³ Private Practice, Darmstadt, Germany; and
⁴ Department of Restorative Dentistry, Harvard School of Dental Medicine, Boston, MA, USA

^* corresponding author, Siegfried.Heckmann{at}zp.med.uni-erlangen.de

The causes of peri-implant bone loss continue to be controversial. To determine the impact of biomechanical stress and inflammation, we investigated a total of 80 interforaminal implants in situ for more than 10 years. Two stress groups, with 14 patients each, were established: a low-stress situation with single-standing implants, and an increased-stress situation with splinted implants. To categorize inflammation, we introduced a Composite Inflammation Score using 4 inflammatory parameters. Peri-implant bone loss was calculated from digital panoramic radiographs. To differentiate between the effects of stress and inflammation, we compared bone loss in both stress groups at equivalent levels of inflammation. With greater Composite Inflammation Score values, a clear discrepancy between single-standing and splinted implants was evident (p = 0.117/0.000, regression analysis; p = 0.135/0.000, analysis of variance; p = 0.002, t tests). While stress and inflammation alone may not necessarily be detrimental factors, the presence of stress heightens peri-implant bone loss significantly as inflammation increases.

KEY WORDS: peri-implant bone loss • biomechanical stress • inflammation • single-standing implants • splinted implants