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Flapless implantology Implant osteotomy hypothesis

The bones are sensitive to heat. Which has led to the implant osteotomy theory to explain early implant bone loss. Implant osteotomy causes trauma to the bone immediately in contact with the implant, whereby an approximately 1 mm zone of devitalized bone is created around the implant. Therefore, renewed blood supply is necessary to remodel the bone at the interface. The crestal region is more susceptible to bone loss during initial repair because of the limited blood supply and relatively greater amount of heat generated at this site owing to the higher bone density.

Bacteria hypothesis

The bacterial hypothesis suggests that the primary cause of bone loss around implants is bacterially induced. The gingival sulcus, into which the implant is placed, has bacterial flora similar to that of natural teeth.  Therefore, a logical assumption is that, if the implants are similar to teeth, the marginal implant bone loss would be caused primarily by bacteria. However, if bacteria were the primary causal agent for initial bone loss, it is unclear why most bone loss occurs during the first year (1.5 mm), with less 0.1 occurring each year thereafter.

Bioliogical width hypothesis

The implant – mucosa barrier comprises a junctional epithelium approximately 2 mm in length,and a connective tissue compartment that ranges from approximately 1 to 1.5 mm in height. This soft tissue barrier constitutes a biological seal around the dental implants, the dimensions of which are called the biological width.

Author’s theory: inflammation, infection, and scarring

The major cause of early implant bone loss appears to be closely related to soft tissue wound healing.