Sadowsky Steven J
Preventive and Restorative Department, University of Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California, USA.
Int J Implant Dent. 2019 Jul 23;5(1):29. doi: 10.1186/s40729-019-0180-8.
Controversy persists as to the role of occlusal overload in peri-implantitis. Animal studies have not revealed the biological threshold for fatigue failure in the peri-implant bone. On the other hand, clinical studies have demonstrated a link between parafunction and implant failure, although variables such as intensity and frequency of loads, as well as bone density, have led to different outcomes. The absence of specific engineering "building codes" for the clinician has relegated prosthetic design planning to intuitive guidelines for all patients. For example, higher crown to implant ratios (2-3:1), implant cantilever prostheses and non-splinted restorative designs have been avoided because of the concern for overload. However, evidence has not supported this general approach. A call for preclinical research to establish specific patient load thresholds is in order to establish a customized treatment plan.
关于咬合负荷过重在种植体周围炎中的作用，争议仍然存在。动物研究尚未揭示种植体周围骨疲劳失效的生物学阈值。另一方面，临床研究表明了异常功能与种植体失败之间的联系，尽管诸如负荷强度和频率以及骨密度等变量导致了不同的结果。由于缺乏针对临床医生的具体工程“建筑规范”，假体设计规划已沦为针对所有患者的直观指导原则。例如，由于担心负荷过重，较高的冠与种植体比例（2-3:1）、种植体悬臂假体和非夹板修复设计已被避免。然而，证据并不支持这种一般方法。需要进行临床前研究以确定特定的患者负荷阈值，以便制定个性化的治疗方案。
