Reconsidering Considering Maximum Bite Force Capacity When Planning Implants
Posted on 12/7/2020 by Greg Kammeyer
In the past, maximum bite force and parafunction were the primary consideration in prosthetic materials and amount of implant support for implant reconstructions. This summary of Dr. Craig Misch’s presentation at a Pikos symposium, briefly updates us on our present understanding of implant size and predictability. Maximum bite force is a key consideration when placing dental implants. This however is not the MOST important one in planning implant treatment. Previous theories on implant loading have been re-evaluated. Longer implants were preferred in the past, providing more surface area for stress distribution. Systematic reviews/meta-analysis on short implants (< 8.0 mm) show no more marginal bone loss and a similar survival rate compared to longer implants (PMID:26804969). Depending on the case type and crown height, there is likely a somewhat higher risk of failure with extra-short implants (6.0 mm or less). Placing the widest implant possible to improve surface area for stress distribution still has merit, yet studies show wider implants may be more susceptible to marginal bone loss, as the volume of surrounding bone is reduced and less likelihood of the 2mm buccal bone width that is critical to long term success. Narrower implants (3 - 3.5 mm) have also shown no difference in survival compared to wider implants (even in posterior tooth replacement (PMID:30328192). I think it is important to understand that there could be a higher risk of technical complications (parts and pieces) in a patient with parafunction but the biologic complications we were warned about (MBL, failure) have not been shown to be a higher risk with shorter and narrower implants, until you reach implants of less than 3.0 mm or 8.0 mm or more. Attributed to Dr Craig M. Misch: At the Pikos symposium, October 2020
Vit D levels are being identified as one of our greatest risk factors. In the future I will blog about the state of the art with Vit D testing and supplementation.
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