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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">To what extent residual alveolar ridge can be preserved by implant? A systematic review</title><author><name sortKey="Khalifa, Ahmed Khalifa" sort="Khalifa, Ahmed Khalifa" uniqKey="Khalifa A" first="Ahmed Khalifa" last="Khalifa">Ahmed Khalifa Khalifa</name><affiliation><nlm:aff id="Aff1">Department of Prosthodontics, Faculty of Dentistry, Mansoura University, 68 ElGomhoria Street, ElMansoura, 35516 Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Wada, Masahiro" sort="Wada, Masahiro" uniqKey="Wada M" first="Masahiro" last="Wada">Masahiro Wada</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Ikebe, Kazunori" sort="Ikebe, Kazunori" uniqKey="Ikebe K" first="Kazunori" last="Ikebe">Kazunori Ikebe</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Maeda, Yoshinobu" sort="Maeda, Yoshinobu" uniqKey="Maeda Y" first="Yoshinobu" last="Maeda">Yoshinobu Maeda</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27878769</idno><idno type="pmc">5120622</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120622</idno><idno type="RBID">PMC:5120622</idno><idno type="doi">10.1186/s40729-016-0057-z</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000E42</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E42</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">To what extent residual alveolar ridge can be preserved by implant? A systematic review</title><author><name sortKey="Khalifa, Ahmed Khalifa" sort="Khalifa, Ahmed Khalifa" uniqKey="Khalifa A" first="Ahmed Khalifa" last="Khalifa">Ahmed Khalifa Khalifa</name><affiliation><nlm:aff id="Aff1">Department of Prosthodontics, Faculty of Dentistry, Mansoura University, 68 ElGomhoria Street, ElMansoura, 35516 Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Wada, Masahiro" sort="Wada, Masahiro" uniqKey="Wada M" first="Masahiro" last="Wada">Masahiro Wada</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Ikebe, Kazunori" sort="Ikebe, Kazunori" uniqKey="Ikebe K" first="Kazunori" last="Ikebe">Kazunori Ikebe</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author><author><name sortKey="Maeda, Yoshinobu" sort="Maeda, Yoshinobu" uniqKey="Maeda Y" first="Yoshinobu" last="Maeda">Yoshinobu Maeda</name><affiliation><nlm:aff id="Aff2">Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Implant Dentistry</title><idno type="eISSN">2198-4034</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>It has been reported that the load for (or to) implant-supported restoration may lead to bone remodeling as bone resorption and/or formation. While many authors supported the process of bone resorption, others elaborated bone apposition and increasing bone density close and remote to implant body (or fixture). This may suggest the role of the implant to reserve alveolar ridge from physiologic/pathologic resorption. The aim of this systematic review was to predict to how extend dental implants can preserve the residual alveolar ridge based on previous clinical investigations.</p></sec><sec><title>Methods</title><p>This systematic review based on the retrospective and prospective studies, randomized clinical trial, and case reports. The process of searching for proposed articles included PubMed, Ovid, and Web of Science databases, with specific inclusion and exclusion criterion.</p></sec><sec><title>Results</title><p>A total 2139 citations were identified. After expunging the repeated articles between databases and application of exclusion and inclusion criteria, 18 articles were found to meet the topic of this systematic review. Many of the articles reported bone preservation with implant-assisted restorations, and the rest denoted noticeable bone apposition.</p></sec><sec><title>Conclusion</title><p>According to the published clinical studies, the behavior of bone remodeling around implant predicts a sort of residual alveolar bone preservation.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Petersen, Pe" uniqKey="Petersen P">PE Petersen</name></author><author><name sortKey="Bourgeois, D" uniqKey="Bourgeois D">D Bourgeois</name></author><author><name sortKey="Ogawa, H" uniqKey="Ogawa H">H Ogawa</name></author><author><name sortKey="Estupinan Day, S" uniqKey="Estupinan Day S">S Estupinan-Day</name></author><author><name sortKey="Ndiaye, C" uniqKey="Ndiaye C">C Ndiaye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nowjack Raymer, Re" uniqKey="Nowjack Raymer R">RE Nowjack-Raymer</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Implant Dent</journal-id><journal-id journal-id-type="iso-abbrev">Int J Implant Dent</journal-id><journal-title-group><journal-title>International Journal of Implant Dentistry</journal-title></journal-title-group><issn pub-type="epub">2198-4034</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27878769</article-id><article-id pub-id-type="pmc">5120622</article-id><article-id pub-id-type="publisher-id">57</article-id><article-id pub-id-type="doi">10.1186/s40729-016-0057-z</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>To what extent residual alveolar ridge can be preserved by implant? A systematic review</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Khalifa</surname><given-names>Ahmed Khalifa</given-names></name><address><phone>20 01113404555</phone><email>a_khalifa@mans.edu.eg</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Wada</surname><given-names>Masahiro</given-names></name><address><phone>+81-6-6879-2954</phone><email>masahiro@dent.osaka-u.ac.jp</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ikebe</surname><given-names>Kazunori</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Maeda</surname><given-names>Yoshinobu</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><aff id="Aff1"><label>1</label>Department of Prosthodontics, Faculty of Dentistry, Mansoura University, 68 ElGomhoria Street, ElMansoura, 35516 Egypt</aff><aff id="Aff2"><label>2</label>Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita Osaka, 565-0871 Japan</aff></contrib-group><pub-date pub-type="epub"><day>23</day><month>11</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>23</day><month>11</month><year>2016</year></pub-date><pub-date pub-type="collection"><month>12</month><year>2016</year></pub-date><volume>2</volume><elocation-id>22</elocation-id><history><date date-type="received"><day>21</day><month>5</month><year>2016</year></date><date date-type="accepted"><day>16</day><month>11</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s). 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>It has been reported that the load for (or to) implant-supported restoration may lead to bone remodeling as bone resorption and/or formation. While many authors supported the process of bone resorption, others elaborated bone apposition and increasing bone density close and remote to implant body (or fixture). This may suggest the role of the implant to reserve alveolar ridge from physiologic/pathologic resorption. The aim of this systematic review was to predict to how extend dental implants can preserve the residual alveolar ridge based on previous clinical investigations.</p></sec><sec><title>Methods</title><p>This systematic review based on the retrospective and prospective studies, randomized clinical trial, and case reports. The process of searching for proposed articles included PubMed, Ovid, and Web of Science databases, with specific inclusion and exclusion criterion.</p></sec><sec><title>Results</title><p>A total 2139 citations were identified. After expunging the repeated articles between databases and application of exclusion and inclusion criteria, 18 articles were found to meet the topic of this systematic review. Many of the articles reported bone preservation with implant-assisted restorations, and the rest denoted noticeable bone apposition.</p></sec><sec><title>Conclusion</title><p>According to the published clinical studies, the behavior of bone remodeling around implant predicts a sort of residual alveolar bone preservation.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Dental implants</kwd><kwd>Ridge preserving</kwd><kwd>Alveolar bone remodeling</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Review</title><sec id="Sec2"><title>Introduction</title><p>Edentulism is rated between 7 and 69% internationally [<xref ref-type="bibr" rid="CR1">1</xref>]. Many biological and non-bilogical predisposing factors lead to the main result of edentulism [<xref ref-type="bibr" rid="CR2">2</xref>]. Regardless the debate to understand the way of resorption [<xref ref-type="bibr" rid="CR3">3</xref>], the loss of periodontal ligament by tooth extraction leaves alveolar bone without a chance of reformation which leads to bone resorption only. The resorption shows variation in rate with recorded fast bone loss at the first 6 months after extraction and the following 2 years [<xref ref-type="bibr" rid="CR4">4</xref>].</p><p>As pernicious sequelae of edentulism, the patient lacks most of the ordinary oral function which requires planned rehabilitation. Implant therapy is one of the recent trends to restore oral functions [<xref ref-type="bibr" rid="CR5">5</xref>–<xref ref-type="bibr" rid="CR7">7</xref>]. Besides the rehabilitation purposes, implants show other favorable biological effects on the bone state. Many authors [<xref ref-type="bibr" rid="CR8">8</xref>–<xref ref-type="bibr" rid="CR10">10</xref>] revealed the ability of the implant to regain bone density at healing and adapt to the applied load. As an evitable fate, residual alveolar ridge shows resorption under the conventional complete denture. This varies according to prosthetic planning, construction, and maintenance, as well as systemic predisposing factors [<xref ref-type="bibr" rid="CR11">11</xref>–<xref ref-type="bibr" rid="CR13">13</xref>]. Although the presence of implant beneath complete or partial denture improves denture foundation and augments patient satisfaction [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR14">14</xref>], there is a controversy about the role of implant overdenture in the process of ridge reshaping after loading.</p><p>The tracing of the bone resorption is difficult for the complete denture with the continuous rated atrophy of the residual alveolar ridge beneath the conventional denture [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR16">16</xref>]. Rather than monitoring the bone atrophy, this review investigates the capability of the implant to be responsible for preserving residual alveolar ridge bone and the role of implant-assisted restoration to reduce the alveolar ridge atrophy.</p></sec><sec id="Sec3"><title>Methods</title><sec id="Sec4"><title>Focus question</title><p>The (PIO) question to be focused was “In patient with implant restoration, what is the chance of residual alveolar ridge preserving and bone formation in the adaptive remodeling and what are the features of this preservation?”</p></sec><sec id="Sec5"><title>Search strategy</title><p>The required documents were collected from PubMed, Web of Science, and Ovid databases. For expanding the traces of researching, further readings for the bibliography of the relevant publications and hand searching for some denoted articles were done. The keywords, for intervention and outcome, used in research engines in databases as “implant overdenture,” “implant bone resorption,” “alveolar ridge preservation,” “improve alveolar ridge,” “implant bone remodeling,” “implant bone reformation,” and “implant bone growth” (Table <xref rid="Tab1" ref-type="table">1</xref>). In all databases, the filters of human, English article, and dental journals were applied.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Systematic search strategy</p></caption><table frame="hsides" rules="groups"><tbody><tr valign="top"><td>Focus question</td><td>In patient with implant restoration, what is the chance of residual alveolar ridge preserving and bone formation in the adaptive remodeling and what are the features of this preservation?</td></tr><tr valign="top"><td colspan="2">Search strategy</td></tr><tr valign="top"><td> Population</td><td>#1—edentulous patient</td></tr><tr valign="top"><td> Intervention</td><td>#2—implant OR overdenture OR fixed bridge OR transmandibular implant OR full rehabilitation</td></tr><tr valign="top"><td> Outcome</td><td>#3—bone density OR volume change OR bone formation OR bone apposition OR bone deposition OR bone preserving OR bone preservation OR bone maintain OR bone increase</td></tr><tr valign="top"><td> Search combination</td><td>#1 AND (#2 OR #3)</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec6"><title>Inclusion and exclusion criteria of studies</title><p>Inclusion criteria for the selected publications included the full-text articles written in English. Case reports also were included. Articles reported bone preservation or bone apposition even in clinical notifications or in the context were included. Studies that revealed improving bone density around implant were involved. The exclusion criteria included papers with only abstract available, while articles that deal only with discussing resorption through the remodeling process around cervical and/or implant body were excluded. Any articles related to abnormal conditions as maxillofacial patients, or treatments of systematic diseased patients, were not considered. Articles related to the effect of the implant on the bone for the opposing arch were excluded. Selection of articles is based on the title and the abstract reading. Some articles were excluded after full reading because of the absence of interest. Other articles were added from the existed citation bibliography (Table <xref rid="Tab1" ref-type="table">1</xref>).</p></sec><sec id="Sec7"><title>Data extraction and assessment</title><p>From the final included articles (<italic>n</italic> = 18), the following characteristics were tabulated:<list list-type="bullet"><list-item><p>Author and the year of publishing</p></list-item><list-item><p>Number of patients and implants mounted</p></list-item><list-item><p>Average age of patients (exact age in case reports)</p></list-item><list-item><p>Area of implant placement</p></list-item><list-item><p>Type of prosthetic restoration</p></list-item><list-item><p>Follow-up period</p></list-item><list-item><p>Bony changes and declarations of the quality and quantity of remodeling (if present)</p></list-item><list-item><p>Study design</p></list-item></list></p></sec></sec><sec id="Sec8"><title>Results</title><p>Initial search retrieved a total 2139 citations. After discarding the repeated articles among databases, revising of titles extruded 668 articles as out of interest for this review. The remaining articles are disclosed more by abstract. We excluded 434 citations due to concentration on bone remodeling with an abnormal situation like compromised patients or with localized problems as maxillofacial patients or not focus on the process of ridge progression under different restorations. The rest of the articles were read carefully to extract conclusions or notices related to positive bone remodeling, bone preserving, bone formation, or increasing bone density of the alveolar ridge with implant. Articles which could not be retrieved as the reference numbers 21 and 22 in the article of Davis et al. [<xref ref-type="bibr" rid="CR17">17</xref>] were not included. Other articles [<xref ref-type="bibr" rid="CR18">18</xref>–<xref ref-type="bibr" rid="CR21">21</xref>] (<italic>n</italic> = 4) were added manually after reading the bibliography of previous citations. The final articles (<italic>n</italic> = 18) were selected according to the previous exclusion and inclusion criteria (Fig. <xref rid="Fig1" ref-type="fig">1</xref>). All citations (<italic>n</italic> = 18) share the point of bone preservation with implant restoration or enhancement of bone density or, at least, reduction of alveolar bone resorption rate after implant placement (Table <xref rid="Tab2" ref-type="table">2</xref>).<fig id="Fig1"><label>Fig. 1</label><caption><p>The final articles (<italic>n</italic> = 18) were selected according to the previous exclusion and inclusion criteria</p></caption><graphic xlink:href="40729_2016_57_Fig1_HTML" id="MO1"></graphic></fig><table-wrap id="Tab2"><label>Table 2</label><caption><p>Clinical studies included</p></caption><table frame="hsides" rules="groups"><thead><tr valign="top"><th></th><th colspan="2">Patients</th><th colspan="3">Intervention</th><th>Follow-up</th><th colspan="2">Outcome</th><th rowspan="2">Study</th></tr><tr valign="top"><th>Reference</th><th>No.</th><th>Age<sup>a</sup></th><th>No. of implants</th><th>Position</th><th>Supra-structure</th><th></th><th>Change</th><th>Declarations</th></tr></thead><tbody><tr valign="top"><td>(DAVIS et al. 1999) [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>44</td><td>61.2</td><td>NG</td><td>Symphyseal</td><td>Fixed</td><td>6.6 Y<sup>a</sup></td><td>VBH (−.8 to +3.3 mm)</td><td>–</td><td>R</td></tr><tr valign="top"><td>(Powers et al. 1994) [<xref ref-type="bibr" rid="CR32">32</xref>]</td><td>146</td><td>52</td><td>NG</td><td>TMI</td><td>Fixed</td><td>18–51 M</td><td>BF (+2 to 9 mm)</td><td>–</td><td>R</td></tr><tr valign="top"><td>(Adell et al. 1981) [<xref ref-type="bibr" rid="CR58">58</xref>]</td><td>410</td><td>53</td><td>2768</td><td>NG</td><td>Removable bridges</td><td>5–9 Y</td><td>BR (+)</td><td>–</td><td>R</td></tr><tr valign="top"><td>(Mericske-Stern et al. 2002) [<xref ref-type="bibr" rid="CR35">35</xref>]</td><td>41</td><td>61.2</td><td>4–6</td><td>Maxillary</td><td>Removable overdentures</td><td>4.1 Y<sup>a</sup></td><td>BD (+)</td><td>Associated with radiographically visible decrease of the crestal bone.</td><td>P</td></tr><tr valign="top"><td>(Kwakman et al. 1997) [<xref ref-type="bibr" rid="CR31">31</xref>]</td><td>36</td><td>60</td><td>NG</td><td>TMI</td><td>Denture with cantilever extension</td><td>2.3 Y<sup>a</sup></td><td>BF (+)</td><td>–</td><td>R</td></tr><tr valign="top"><td>(Sennerby et al. 1988) [<xref ref-type="bibr" rid="CR72">72</xref>]</td><td>41</td><td>51.3</td><td>NG</td><td>Symphyseal</td><td>Oerdenture</td><td>7.1 Y<sup>a</sup></td><td>BR (−)</td><td>Implant bony area vs CD</td><td>R</td></tr><tr valign="top"><td>(Friberg et al. 2000) [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td>49</td><td>63</td><td>247</td><td>NG</td><td>Fixed prosthesis</td><td>8 Y<sup>a</sup></td><td>BF (+)</td><td>At two most distal implants</td><td>R</td></tr><tr valign="top"><td>(Adell et al. 1986) [<xref ref-type="bibr" rid="CR19">19</xref>]</td><td>16</td><td>53</td><td>95</td><td>Maxillomandibular</td><td>Removable bridge</td><td>3 Y<sup>a</sup></td><td>BR (+)</td><td>Indicating a successive load-related remodeling</td><td>P</td></tr><tr valign="top"><td>(Kordatzis et al. 2003) [<xref ref-type="bibr" rid="CR74">74</xref>]</td><td>150</td><td>NG</td><td>300</td><td>Symphyseal</td><td>Bar overdenture</td><td>5 Y<sup>a</sup></td><td>BR (−1 mm)<sup>a</sup></td><td>Less bone atrophy with OD vs CD.</td><td>R</td></tr><tr valign="top"><td>(Woven & Gotfredsen 1998) [<xref ref-type="bibr" rid="CR78">78</xref>]</td><td>22</td><td>65</td><td>NG</td><td>Symphyseal</td><td>Overdentures</td><td>5 Y<sup>a</sup></td><td>BF (+)<break></break>BR (−)</td><td>Function related BF vs physiologic age-related BR</td><td>P</td></tr><tr valign="top"><td>(Wright et al. 2002) [<xref ref-type="bibr" rid="CR73">73</xref>]</td><td>44</td><td>53 Y, for overdenture and 64 Y for the fixed prosthesis</td><td>NG</td><td>NG</td><td>Overdentures and fixed prostheses</td><td>7.5 Y<sup>a</sup></td><td>BR (−0.5 mm)<sup>a</sup> BF (+0.5 mm)<sup>a</sup></td><td>OD and FD, respectively</td><td>R</td></tr><tr valign="top"><td>(Shaarawy & Aboelross 2013) [<xref ref-type="bibr" rid="CR92">92</xref>]</td><td>14</td><td>58</td><td>14 + 28</td><td>Symphyseal and 2 in the first molar area</td><td>Overdenture</td><td>1 Y</td><td>BD (+)</td><td>Incisal reduction of BD followed by gradual increase in BD</td><td>P</td></tr><tr valign="top"><td>(Taylor 1989) [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>1</td><td>50 Y (not a mean)</td><td>5</td><td>NG</td><td>Fixed</td><td>32 M</td><td>VBH (3 mm)</td><td>–</td><td>CR</td></tr><tr valign="top"><td>(Oikarinen & Siirila 1992) [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>1</td><td>41 Y</td><td>6</td><td>NG</td><td>Fixed</td><td>8 Y<sup>a</sup></td><td>VBH (+)</td><td>Nearly the doubled new BF</td><td>CR</td></tr><tr valign="top"><td>(Betts et al. 1993) [<xref ref-type="bibr" rid="CR18">18</xref>]</td><td>19</td><td>NG</td><td>NG</td><td>TMI</td><td>Fixed</td><td>53 M</td><td>VBH (+1.8 mm)<sup>a</sup></td><td>In the saddle area and the most distal screw</td><td>R</td></tr><tr valign="top"><td>(Dhima et al. 2013) [<xref ref-type="bibr" rid="CR33">33</xref>]</td><td>81</td><td>NG</td><td>NG</td><td>NG</td><td>Fixed</td><td>9<sup>a</sup></td><td>BF (+0.94 mm)<sup>a</sup></td><td>–</td><td>R</td></tr><tr valign="top"><td>(Mosnegutu et al. 2015) [<xref ref-type="bibr" rid="CR81">81</xref>]</td><td>82</td><td>NG</td><td>NG</td><td>NG</td><td>Overdenture</td><td>10.5 Y<sup>a</sup></td><td>BR (±)</td><td>No relevant posterior bone atrophy after loading</td><td>P</td></tr><tr valign="top"><td>(Cooper et al. 2008) [<xref ref-type="bibr" rid="CR79">79</xref>]</td><td>59</td><td>NG</td><td>118</td><td>Parasymphyseal</td><td>Overdenture</td><td>60 M</td><td>BF (+)</td><td>–</td><td>P</td></tr></tbody></table><table-wrap-foot><p><sup>a</sup>Average</p><p><italic>NG</italic> not given, <italic>TMI</italic> transmandibular implant, <italic>Y</italic> year, <italic>M</italic> month, <italic>BF</italic> bone formation, <italic>VBH</italic> vertical bone height, <italic>BR</italic> bone radiopacity, <italic>BD</italic> bone density, <italic>BR</italic> bone resorption, <italic>CD</italic> complete denture, <italic>OD</italic> overdenture, <italic>FD</italic> fixed denture, <italic>R</italic> retrospective, <italic>P</italic> prospective, <italic>CR</italic> case report, (<italic>+</italic>) increase, (<italic>−</italic>) decrease, (<italic>±</italic>) neutral</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec9"><title>Discussion</title><sec id="Sec10"><title>Implant role to enhance bone density</title><p>Apparently, there is an enduring adaptive process surrounding the implant which sustains the rigid interface between alveolar bone and implant after non-destructive surgical and loading procedures. Like other body bones, and according to Wolff’s law, bone has the ability to differentiate with different stresses applied [<xref ref-type="bibr" rid="CR22">22</xref>]. This reform is started from the time of surgical conduction of implant and continued to support the implant to withstand the uploading forces [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR23">23</xref>–<xref ref-type="bibr" rid="CR25">25</xref>]. Greater bone modification may occur at the alveolar bone around implants in partially edentulous patients [<xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR27">27</xref>]. Roberts et al. [<xref ref-type="bibr" rid="CR28">28</xref>] described the situation and the process as the ankylosed tooth which acts without bracing the attachment to bone and carries a heavy load. The adaptive modeling of endosseous implants, as a response to load, is a massive build-up of immature buttress-like skeleton which then decrease externally as the interior layers become more mature [<xref ref-type="bibr" rid="CR28">28</xref>].</p><p>Like ankylosed tooth, implant-supported fixed prosthetic treatment might have a preservative effect on residual alveolar bone [<xref ref-type="bibr" rid="CR29">29</xref>]. A radiographic-based quantitative study carried by Ichikawa et al. [<xref ref-type="bibr" rid="CR30">30</xref>] displayed an improvement of bone density and bone formation related to load applied after a short period of implant service. With transmandibular implant, bone maintaining [<xref ref-type="bibr" rid="CR18">18</xref>] or even formation and the highest increase in the bone were recorded [<xref ref-type="bibr" rid="CR31">31</xref>]. The study for 146 patients with severely resorbed ridge treated with transmandibular implant denoted bone formation with all cases during follow-up period extended 51 months [<xref ref-type="bibr" rid="CR32">32</xref>]. Within 9-year follow-up for 81 patients, Dhima et al. [<xref ref-type="bibr" rid="CR33">33</xref>] denoted about 0.94 mm growth of bone. In a different study, peri-implant bone density grew around implants after 5 years of follow-up [<xref ref-type="bibr" rid="CR34">34</xref>]. Even with questionable histological bony condition, as in the maxilla with sinus lifting, favorable bone density is noticed [<xref ref-type="bibr" rid="CR35">35</xref>, <xref ref-type="bibr" rid="CR36">36</xref>]. Follow-up for more than 3 years for 44 installed fixtures revealed a consistent bone formation and elevation of lining sinus mucosa without bone graft. [<xref ref-type="bibr" rid="CR37">37</xref>] This goes with the conclusion of Lundgren et al. [<xref ref-type="bibr" rid="CR38">38</xref>] as the replaceable bone window allows bone formation with the implant after sinus lift.</p><p>Bone changes were reported after implant placement in three phases: healing, remodeling, and equilibrium. The remodeling phase is launched confronting the altered pattern of force transmission to the bone tissue. To withstand the applied functional load, continuous remodeling is conducted to reach a “steady state.” Mechanical stimulus is the primary bone modifier influenced by other in situ variables as hormonal, metabolic, genetic factors [<xref ref-type="bibr" rid="CR39">39</xref>].</p><p>Clinically, as affordable as the strain, bone regeneration is configured, whereas the over-stimulation leads to adverse effects [<xref ref-type="bibr" rid="CR40">40</xref>]. The bone around unloaded implants showed a low mineral density index. [<xref ref-type="bibr" rid="CR41">41</xref>] The process of inducing more dense bone depends mainly on the loading protocol conducted [<xref ref-type="bibr" rid="CR42">42</xref>]. The peri-implant bone around progressively loaded implants illustrated minimal crestal bone loss than the bone around implants placed conventionally, and the later cited extended increase in peri-implant bone density by time [<xref ref-type="bibr" rid="CR10">10</xref>]. Based on radiological assessment, Barone et al. [<xref ref-type="bibr" rid="CR43">43</xref>] stated statistical significant dense bone around immediate rather than unloaded oral implants.</p><p>Histochemically, the mechanical effect controls bone formation and mass modification with a percentage about 40% comparing to other growth-related factors as hormonal or cytokine deliver about 10% of the postnatal changes in bone strength and mass. Thereby, mineralization and tissue reformation by osteoblasts are co-related to the local mechanical environment [<xref ref-type="bibr" rid="CR44">44</xref>]. The blood supply and nutrition are mandatory as osteoblast acting on the osteoid bone formation [<xref ref-type="bibr" rid="CR45">45</xref>]. Bone tissue that experienced physiologic load is liable for osteogenic deformation [<xref ref-type="bibr" rid="CR46">46</xref>]. Thus, strain must be in the physiologic bone limit (500–3000 μ strain) according to the elasticity modulus, while overstrain (>5000 μ strain) precipitates fibrogenesis [<xref ref-type="bibr" rid="CR44">44</xref>, <xref ref-type="bibr" rid="CR47">47</xref>].</p></sec><sec id="Sec11"><title>Variations of bone resorption and preserving with different restorations</title><p>Considering physiologic changes, the annual alveolar bone resorption is approximately fourfold more in mandible comparing to the maxilla [<xref ref-type="bibr" rid="CR48">48</xref>]. A longitudinal monitoring of edentulous complete denture wearers admitted continuous reduction of the residual alveolar ridge throughout the study. The anterior part of the mandible showed the higher average of reduction compared to the estimated rate of the maxilla [<xref ref-type="bibr" rid="CR49">49</xref>]. The variation between the jaws in alveolar bone reduction increased gradually during the first years of denture wearing. This evidenced the unfavorable response of the mandible to various functional stresses transmitted through the denture to the limited and diminished bearing area of the mandibular alveolar bone comparing to the maxilla [<xref ref-type="bibr" rid="CR50">50</xref>].</p><p>Many procedures are used to recover denture foundation, but the majority is considered sophisticated techniques [<xref ref-type="bibr" rid="CR51">51</xref>–<xref ref-type="bibr" rid="CR53">53</xref>]. Observations tried to notify bone modifications with different types of implant-assisted restoration [<xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR40">40</xref>, <xref ref-type="bibr" rid="CR54">54</xref>]. The clinical and radiographic investigations, detection of the altered mineral levels, or bone density within the bone may give a valuable data for the bony state around loaded implants [<xref ref-type="bibr" rid="CR55">55</xref>–<xref ref-type="bibr" rid="CR57">57</xref>]. In a prospective study, Adell et al. [<xref ref-type="bibr" rid="CR19">19</xref>] noticed a reduction of probing depth around implants, resembling approximately that surround natural dentition which indicates active positive bone repair. A further sign of bone preserving is the radiopacity close to the fixture due to increasing in density [<xref ref-type="bibr" rid="CR58">58</xref>]. Such radiopacity affirmed to increased bone volume and/or increased mineral content. Maxillary implants reflected more bone density rather than mandibular and distal cantilevered implants due to the stresses which may produce more unfavorable bone restoring condition. After 10 years of implant placement, a significant increase in peri-implant bone density was noted in a clinical study for 18 patients [<xref ref-type="bibr" rid="CR59">59</xref>]. In two separate clinical reports, Taylor [<xref ref-type="bibr" rid="CR21">21</xref>] reported patient’s complain with cantilevered part after 32 months of loading. He elaborated that with mandibular growing for about 3 mm. In the other case report by Oikarinen and Silrila [<xref ref-type="bibr" rid="CR60">60</xref>], they mentioned new boney layer formation. Naert et al. [<xref ref-type="bibr" rid="CR61">61</xref>] agreed with the role of the implant in residual ridge preservation even if there is no bone formation recorded.</p></sec><sec id="Sec12"><title>Destructive and preservative role of implant overdenture</title><p>Occlusal load and different forces induced on the implant overdenture restoration, with the diminished supportive area, might be the main predisposing factor for bone resorption [<xref ref-type="bibr" rid="CR62">62</xref>]. According to finite element analysis study, the available bearing area in case of complete denture is 4608.7 mm<sup>2</sup> comparing to 2833.4 mm<sup>2</sup> for the implant overdenture posteriorly which leads to an even pressure at the usage of complete denture comparing to higher load concentration on the posterior area available with overdenture [<xref ref-type="bibr" rid="CR63">63</xref>]. This agreed with other study comparing hydrostatic pressure under the conventional versus implant overdenture which conceded the evenness of load distribution over the wide area of residual ridge, approximately 1926 mm<sup>2</sup>, and the volume average hydrostatic pressure at 10.670.8 kPa, in case of complete denture. While the tissue-bearing area reduced to 71% with two implants and to 60.5% for four implant-assisted overdenture, the corresponding hydrostatic pressure was 14.370.9 and 13.370.9 kPa, respectively. The peak of posterior stresses was recorded with the two implant-assisted overdentures [<xref ref-type="bibr" rid="CR64">64</xref>]. In a clinical retrospective study for 10 years, there was a significant difference in posterior ridge resorption with overdenture assisted with two and/or four implants. This was interpreted as the improved oral function and increased bite force may lead to more force concentration which does not exist in floated conventional denture [<xref ref-type="bibr" rid="CR65">65</xref>]. Due to the anchorage of the denture anteriorly in the symphyseal area, the axial direction of force and the free movement posteriorly may exert more resorption in comparing to preserved bone close to implant anteriorly [<xref ref-type="bibr" rid="CR66">66</xref>, <xref ref-type="bibr" rid="CR67">67</xref>]. On the other hand, the best selection for supra-structure attachment with implant overdenture and the pre-intervention planning may reduce implant/ridge load by distributing forces in an even manner to act as the norm of implant-supported fixed dentures [<xref ref-type="bibr" rid="CR68">68</xref>, <xref ref-type="bibr" rid="CR69">69</xref>]. Additional investigation elected the symphyseal implant overdenture as a good treatment modality without overestimation for posterior bone loss [<xref ref-type="bibr" rid="CR70">70</xref>].</p><p>Despite age-related [<xref ref-type="bibr" rid="CR71">71</xref>], local and/or systemic factors causing prolonged ridge resorption [<xref ref-type="bibr" rid="CR9">9</xref>], authors reported the probability of preservative effect and overhaul to maintain the residual alveolar ridge with different restoration [<xref ref-type="bibr" rid="CR70">70</xref>, <xref ref-type="bibr" rid="CR71">71</xref>]. In the previous study, bone formation was noticed with the distal implant in severely resorbed atrophied mandibular ridge [<xref ref-type="bibr" rid="CR20">20</xref>]. Sennerby et al. [<xref ref-type="bibr" rid="CR72">72</xref>] concluded that the treatment with tissue-integrated prostheses seems to reduce bone resorption in the mandible, probably owing to adequate favorable load to stimulate bone preservation. Patients rehabilitated with implant-stabilized mandibular overdenture demonstrated the preservation of posterior mandibular residual ridge from resorption by annual range +0.009 to − 0.048 mm, while patients with mandibular implant fixed cantilever prostheses elaborated bone apposition, in the same area, with 1.6% annually [<xref ref-type="bibr" rid="CR73">73</xref>]. Additionally, Kordatzis et al. [<xref ref-type="bibr" rid="CR74">74</xref>] concluded 1-mm annual reduction in bone loss at using implant overdenture comparing to the conventional denture. Davis et al. [<xref ref-type="bibr" rid="CR17">17</xref>] noticed the liability of the severely resorbed mandible for regeneration. After more than 4 years of function, anterior implant regenerated bone in the mental foramen area created a mandibular canal that previously was unseen. Even with loaded comparing to non-loaded implant in the same patient, the loaded implant demonstrated more bone preservation [<xref ref-type="bibr" rid="CR75">75</xref>]. Within the 4-year study of implant-supported overdenture, preservation and gaining of more bones were preserved. Clinical examination revealed 0.8 mm mean annual marginal bone loss during the first year and 0.1 mm in the following years [<xref ref-type="bibr" rid="CR76">76</xref>]. Also, the bony area close to the implants has advantaged reduction in bone resorption. The reduced resorption rate with implant-supported overdenture is significantly proportional to the distance from the distal implant which contributes to protecting the posterior residual ridge from excessive loading [<xref ref-type="bibr" rid="CR74">74</xref>, <xref ref-type="bibr" rid="CR77">77</xref>]. In a retrospective 5-year study, 22 patients with bar retained and freestanding implant overdenture patients demonstrated a significant preservation of bone surrounding implant. The increased function after prosthetic rehabilitation reflected load-related bone deposition which minimized the physiologic age-related mandibular bone mineral content loss regardless the attachment system [<xref ref-type="bibr" rid="CR78">78</xref>]. A non-significant bone gain was recorded with 59 patients after wearing overdenture for 60 months [<xref ref-type="bibr" rid="CR79">79</xref>]. Another clinical investigation, extended for 8 years, proved the usage of bar-assisted overdenture in the treatment of severely resorbed alveolar ridge represented preservation and minimal rate bone resorption regardless the design of bar [<xref ref-type="bibr" rid="CR80">80</xref>]. The same conclusion was announced by Mosnegutu et al. [<xref ref-type="bibr" rid="CR81">81</xref>] after 10 years of follow-up for some cases. Transmission of load axially toward implant followed by posterior load on the ridge initiated a negative consequence on the posterior bone and preservative positive alveolar bone response around osseointegrated implants [<xref ref-type="bibr" rid="CR82">82</xref>]. Development of high strain in the alveolar region is inevitable causing crestal bone resorption [<xref ref-type="bibr" rid="CR83">83</xref>, <xref ref-type="bibr" rid="CR84">84</xref>]. Strain levels in peri-implant bone are reduced as the insertion depth of the implant increased [<xref ref-type="bibr" rid="CR85">85</xref>]. The chance of bone preserving is high in normal range of load and in the absence of abnormal overload conditions [<xref ref-type="bibr" rid="CR69">69</xref>].</p><p>As most of the previous studies declared the favorable bone preservation of the residual alveolar ridge anteriorly around implants, biomechanically, and according to finite element analysis, bone modifying shows variations depending on the cancellous or cortical nature. Bone density is enhanced gradually from the third month to the end of the first year of loading coming stable after 30 months. Whoever, bone adaptive activities expose more impact on cancellous areas more than other parts [<xref ref-type="bibr" rid="CR86">86</xref>]. Favorable bone remodeling may occur close to implants in partially edentulous patient because of the chance to be surrounded by alveolar rather than basal bone [<xref ref-type="bibr" rid="CR26">26</xref>]. Thus, the cortical bone reveals more force concentration and liability to resorb rather than the cancellous bone showing more liability to accommodate with the induced forces [<xref ref-type="bibr" rid="CR87">87</xref>, <xref ref-type="bibr" rid="CR88">88</xref>]. According to Chou et al. [<xref ref-type="bibr" rid="CR89">89</xref>], the topography of the fixture reported alternative responses to load promotes a variation of bone remodeling. Due to the diminished bone surrounding, mini-implants revealed less bone adaptive capacity [<xref ref-type="bibr" rid="CR90">90</xref>]. The threaded fixture represented bone apposition at the tip of threads and subsequent resorption at the bottoms. The non-threaded smooth implant revealed increasing in bone density at the apical section with a connection of high-density region to the cortical bone. According to Li et al. [<xref ref-type="bibr" rid="CR91">91</xref>], positive density was illustrated deeper to the implant surface which may be due to the mechanical stimulus on the favorable cancellous bone.</p></sec></sec></sec><sec id="Sec13"><title>Conclusions</title><p>Within the limitation of this review and based on previous studies, implant restoration has a noticeable residual alveolar ridge preservation which varies from reducing rate of physiologic resorption to bone apposition. However, the extension of this preservation from the implant to surrounding bony area, horizontally and vertically, is unknown. So, further studies are needed to elaborate the extension of preservation and the influencing factors.</p></sec></body><back><ack><sec id="FPar1"><title>Competing interests</title><p>Ahmed Khalifa Khalifa, Masahiro Wada, Kazunori Ikebe, and Yoshinobu Maeda declare that they have no competing interests.</p></sec><sec id="FPar2"><title>Author’s contribution</title><p>AK drafted the manuscript. MW and IK helped to draft the manuscript. YM conceived of the study, participated in its design and coordination, and helped to draft the manuscript. 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