Under pressure: Unraveling the impact of occlusal overload on peri‐implant health–A systematic review
Sean Mojaver, Nupur Patel, Héctor Sarmiento, Joseph P. Fiorellini
Abstract
PURPOSE: To evaluate the impact of occlusal trauma and excessive occlusal loading on dental implant health, with a focus on marginal bone loss and the incidence of peri-implantitis. The review aims to clarify how nonphysiological occlusal forces influence stress distribution around implants and contribute to clinical complications. METHODS: A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between January 2000 and October 2023. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, case-control studies, experimental investigations, and systematic reviews that investigated the effects of occlusal overload on peri-implant tissues. Of 160 initially identified references, 80 studies met the inclusion criteria and were analyzed for relevant outcomes. RESULTS: Quantitative findings revealed that marginal bone loss associated with occlusal factors ranged from approximately 0.65 mm to 1.20 mm. In contrast, traumatic occlusal forces produced bone level changes of 1.0 mm to 3.0 mm and were associated with peri-implantitis rates ranging from 20% to 50%. Variations in occlusal scheme design and the presence of parafunctional habits such as bruxism were identified as significant modulators of biomechanical stress and clinical outcomes. The review also identified a synergistic relationship between mechanical overload and bacterial biofilm in accelerating peri-implant tissue breakdown. CONCLUSIONS: Excessive occlusal loading and trauma are critical contributors to marginal bone loss and peri-implantitis. These findings underscore the importance of meticulous occlusal management and individualized treatment planning, particularly in patients with parafunctional habits. Further high-quality studies are needed to establish evidence-based occlusal protocols that mitigate biomechanical risks and enhance long-term implant success.