Assessing bone's adaptive capacity around dental implants: a literature review.

ABSTRACT Background Increased stress (force) on prostheses induces strain (deformation) in the peri-implant bone. Elevated stress and strain could result in the failure of implants that support prostheses. However, the survival rate of implants supporting prostheses under increased stress is high. Either the bone is stronger than expected or it adapts to increased stress. Concepts regarding bone's adaptive capacity continue to evolve and are the focus of this literature review. Types of Studies Reviewed The authors searched the literature to find studies that addressed the bone's capacity to adjust to increased stress and strain. They assessed experimental and clinical trials in which investigators monitored healing after placement of dental implants. Results The data indicate that forces greater than the bone's adaptive ability can induce loss of osseointegration, as well as osseous resorption. In contrast, it is possible that increased stress on prostheses initiates a reparative process, thereby facilitating retention of implants experiencing increased stress. Numerous lines of evidence support the concept that bone can modify itself to withstand increased mechanical forces. Practical Implications The authors provide an explanation for the high success rate of prostheses and implants in bone that are exposed to increased stress and strain.