The same
finding was reported by Rosenberg et al[15] for implants with hydroxyapatite surface enhanced by patients’ conditions (periodontally compromised). This may be due to ease of microbial adhesion to rough compared to the machined surface. Teughels et al[24] conducted a systematic review of the literature on the effect of material characteristics and/or surface topography of the implant in the development of the biofilm (plaque), concluding that implant surfaces with a higher find more degree of roughness (R = 0.2 μm) facilitate biofilm formation. In a retrospective evaluation of predisposing conditions for the occurrence of retrograde peri-implant pathology in Brånemark system implants, Quirynen et al[12] observed a higher incidence of retrograde peri-implant pathology in TiUnite (rough) (Nobel Biocare) implants. The components of an implant-prosthetic rehabilitation (abutment, abutment screw, and crown/prosthesis)
may relate to the occurrence of peri-implant pathology, to the extent that they are part of the equation when the disease occurs by occlusal overload.[25] Regarding the abutments, there is no evidence that the different surface topography influences the accumulation of plaque either in the animal model[26] or in a human model as evidenced by Van Assche et al[27] through GSK-3 inhibitor a randomized clinical trial comparing the accumulation of plaque on different surfaces. Regarding the type of prosthetic reconstruction, a higher incidence of implant failures and prosthetic complications have been observed in partially edentulous patients rehabilitated with a fixed partial prosthesis supported by two implants compared to a prosthesis supported by three or more implants.[28-30] This may occur due to a biomechanically unfavorable situation with respect to the number of implants supporting the structure.[31] The type of restorative material used in the prosthesis ranges from acrylic, metal-acrylic, metal-ceramic, and to ceramic. The academic hypothesis of using acrylic as a means
of reducing the concentration of occlusal stress on the bone/implant interface[32] Avelestat (AZD9668) acting as a shock absorbing agent has been postulated; this assumption is supported by finite element analysis studies and mathematical models.[33, 34] However, there were no significant differences in marginal bone loss between implants restored with ceramic or acrylic in clinical studies.[35] The presence of cantilevers in a fixed prosthesis has been considered a risk factor due to the considerable increase of occlusal load on the implants, especially the most distal implant.[32] These results have been supported by in vitro studies,[36-38] suggesting a maximum limit of a 15-mm-long cantilever in the mandible.[38] A recent meta-analysis from retrospective cohort studies concluded that there were no differences in bone loss in implants supporting a cantilever because of this factor per se.