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Flapless implantology Causes of early bone loss

An understanding of the causes of early crestal bone loss around the dental implants is critical to prevent such occurrences. Several hypotheses have been suggested. Ranging from reflection of the periosteum during surgery, preparation of the implant osteotomy, bacterial invasion, the establishment of a biological width, and the presence of stress factors.

Periosteal reflection hypothesis

The cortical bone blood supply is affected dramatically when the periosteum is reflected off the crestal bone, resulting in osteoblast death on the surface from both trauma and lackof nutrition. These events support the periosteal reflection theory as a cause for the early bone loss around an implant. The periosteal reflection theory suggests that generalized horizontal bone loss of the entire reflected residual ridge should occur instead of localized ditching around the implant.

It is believed that the bone loss caused by periosteal reflection may depend on the degree of periosteal vessel breakdown. Bone loss occurs in cases where there is severe damage to the blood supply of the periosteum.

However, the periosteum maintains its ability to generate new bone despite periosteal reflection in patients where surgery causes little damage to the blood vessels of the periosteum.