Aust Dent J. 2008 Jun;53 Suppl 1:S60-8. doi: 10.1111/j.18347819.2008.00043.x. Occlusion in implant dentistry.

A review of the literature of prosthetic determinants and current concepts. Gross MD. Source Department of Oral Rehabilitation, Tel Aviv School of Dental Medicine, Tel Aviv University, Israel. grossmd@post.tau.ac.il Abstract Today the clinician is faced with widely varying concepts regarding the number, location, distribution and inclination of implants required to support the functional and parafunctional demands of occlusal loading. Primary clinical dilemmas of planning for maximal or minimal numbers of implants, their axial inclination, lengths and required volume and quality of supporting bone remain largely unanswered by adequate clinical outcome research. Planning and executing optimal occlusion schemes is an integral part of implant supported restorations. In its wider sense this includes considerations of multiple inter-relating factors of ensuring adequate bone support, implant location number, length, distribution and inclination, splinting, vertical dimension aesthetics, static and dynamic occlusal schemes and more. Current concepts and research on occlusal loading and overloading are reviewed together with clinical outcome and biomechanical studies and their clinical relevance discussed. A comparison between teeth and implants regarding their proprioceptive properties and mechanisms of supporting functional and parafunctional loading is made and clinical applications made regarding current concepts in restoring the partially edentulous dentition. The relevance of occlusal traumatism and fatigue microdamage alone or in combination with periodontal or periimplant inflammation is reviewed and applied to clinical considerations regarding splinting of adjacent implants and teeth, posterior support and eccentric guidance schemes. Occlusal restoration of the natural dentition has classically been divided into considerations of planning for sufficient posterior support, occlusal vertical dimension and eccentric guidance to provide comfort and aesthetics. Mutual protection and anterior disclusion have come to be considered as acceptable therapeutic modalities. These concepts have been transferred to the restoration of implant-supported restoration largely by default. However, in light of differences in the supporting mechanisms of implants and teeth many questions remain unanswered regarding the suitability of these modalities for implant supported restorations. These will be discussed and an attempt made to provide some current clinical axioms based where possible on the best available evidence. Clin Oral Implants Res. 2005 Feb;16(1):26-35. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Kim Y, Oh TJ, Misch CE, Wang HL. Source Department of Periodontics/Prevention/Geriatrics, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109, USA. Abstract Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for periimplant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a longterm implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success. Int Dent J. 2008 Jun;58(3):139-45.

Guidelines for occlusion strategy in implant-borne prostheses. A review. Rilo B, da Silva JL, Mora MJ, Santana U. Source benitorilop@yahoo.es Abstract Medium- or long-term failure of endosseous dental implants after osseointegration, when it has occurred, has been associated in the great majority of cases with occlusal overload. Overload depends ultimately on the number and location of occlusal contacts, which to a great extent are under the clinician's control. Much of our current understanding of occlusal contacts in this context is based on concepts derived from non-implant-borne prosthetics and has not been rigorously tested. The present article reviews occlussal contact designs and offers occlusion strategy guidelines for the main types of implant-borne prostheses. Considerations when planning occlusal rehabilitation: a review of the literature. R W Wassell, J G Steele, G Welsh Department of Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK. As one of the most demanding tasks facing the restorative dentist, planning and executing an occlusal rehabilitation should not be undertaken lightly. The stakes are high and failure is costly. Treatment planning decisions should be undertaken on the basis of scientific evidence, where this is available, or on the basis of documented experience where it is not. This review article identifies the major biological and clinical considerations used when planning an occlusal rehabilitation. These include the indications for reorganising the occlusion, the choice of condylar position and occlusal scheme, the implications of and indications for increasing the vertical dimension, replacing missing teeth and the choice of materials. Finally, the literature surrounding the controversial issue of occlusal rehabilitation as a means to treat temporomandibular disorders is also reviewed. Keywords: occlusal; rehabilitation; plan; when plan; consideration when; condylar position; consideration; condylar; review; occlusal scheme; literature; temporo-mandibular; vertical dimension; dentist; miss teeth; Nihon Hotetsu Shika Gakkai Zasshi. 2008 Jan;52(1):25-30. [Significance of occlusion for dental implant treatment. Clinical evidence of occlusion as a risk factor]. [Article in Japanese] Hosokawa R. Source Department of of Oral Functional Reconstruction, Kyushu Dental College, Japan. hosokawa@kyu-dent.ac.jp Abstract It is believed that one of the potential risk factors for periimplant bone loss and failure of the implant /implant prosthesis may be occlusal overloading. Overloading factors, e.g parafunctions, may negatively influence on implant longevity, however, It must be emphasized that currently there is little evidence regarding implant failure caused by overloading. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide possible solutions managing complications related to parafunctions. This paper summarizes the lecture presented at the International Congress of Prosthodontics 2007 in Kobe. Nihon Hotetsu Shika Gakkai Zasshi. 2008 Jan;52(1):1-9. [Does evidence of implant occlusion exist?]. [Article in Japanese] Matsushita Y, Sasaki K, Koori H, Esaki D, Haruta A, Koyano K. Source Division of Oral Rehabilitation, Kyushu University, Japan. matsushi@dent.kyushu-u.ac.jp Abstract This article reviews epidemiologic studies and basic researches concerning the mechanical risk factors that cause overload in implant occlusion. When natural teeth are adjacent to an implant, occlusal contact on the implant prosthesis requires a reduced initial mechanical load on the implant. This is called the implant-protected occlusion concept. However, few studies support this concept, and several researchers are concerned about the influence on the temporomandibular joint

and the adjacent teeth when using this occlusal concept. It is thought that the same initial mechanical load on the implant and adjacent teeth does not result in an overload on the implant itself. The influence of a non-axial load, large cantilevers, and offset loading with a large occlusal table is greater than that of the axial load because of the bending moment. However, no epidemiologic study supports the biological influences of overloading. Meta-analysis of the connection of natural teeth and implants shows the biological and prosthetical risks Dent Update. 2010 Nov;37(9):610-2, 615-6, 619-20. Occlusal considerations in implantology: good occlusal practice in implantology. Davies SJ. Source TMD Clinic, Manchester University Dental School, UK. Abstract This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion. CLINICAL RELEVANCE: This article aims to provide the basis for guidelines for good occlusal practice in implantology. It will consider these under two headings: those which could be considered as basic occlusal principles; and those occlusal considerations that are specific to implants. Republished in SADJ. 2011 Mar;66(2):62, 64-9. Occlusal considerations in implantology: good occlusal practice in implantology. Davies SJ. Source: TMD Clinic, Manchester University Dental School, UK. Abstract This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion. Compendium. 1994 Nov;15(11):1330, 1332, 1334 passim; quiz 1344. Implant-protected occlusion: a biomechanical rationale. Misch CE, Bidez MW. Source Oral Implant Center and Residency, University of Pittsburgh, School of Dental Medicine, Pennsylvania, USA. Abstract The clinical success and longevity of endosteal dental implants are controlled, in a large part, by the mechanical milieu within which they function. The occlusion is a critical component of such a mechanical environment. "Implant-protected occlusion" refers to an occlusal schema that is often uniquely specific to the restoration of endosteal implant prostheses. Implant orientation and the influence of load direction, the surface area of implants, occlusal table width, and protecting the weakest area are blended together from a biomechanical rationale to provide support for a specific occlusal philosophy. Odontology. 2009 Jan;97(1):8-17. doi: 10.1007/s10266-0080096-x. Epub 2009 Jan 29. Dental occlusion: modern concepts and their application in implant prosthodontics. Carlsson GE. Source Department of Prosthetic Dentistry, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30, Gteborg, Sweden. g.carlsson@odontologi.gu.se Abstract The aim of this article was to review the literature on various aspects of occlusion related to implant prosthodontics, using

PubMed and the Cochrane library. Even if the number of studies on implants and prosthodontics is very large, no randomized controlled trials or Cochrane reviews were found on the possible influence of occlusal design or characteristics of occlusion on treatment outcome. Therefore, studies and articles of a lower evidence level were accepted as the main part of the review. The widely spread opinion that implants are superior to natural teeth was refuted by two recent consensus conferences, which concluded that the long-term outcome of implant restorations is not better than that of natural teeth. No controlled studies on the optimal features of a harmonious natural and/or restored occlusion, including implant prostheses, were found. Nor was there any evidence that more sophisticated methods in jaw registration, e.g., using facebows and adjustable articulators, compared with simpler methods, will yield better clinical prosthodontic results. This article discusses, among other things, concepts of occlusion of implant-supported restorations, occlusal material, cantilevers, and occlusal risk factors. Within the limitations of the review, it was concluded that many factors can influence implant failure and peri-implant bone loss but that little is known of the relative importance of such factors. Most probably, however, occlusal factors and details of occlusion are in general of minor importance for the outcome of implant restorations. Occlusion can be managed successfully by using simple methods for jaw registration and different occlusal concepts. J Oral Implantol. 2003;29(5):230-4. Occlusal principles and clinical applications for endosseous implants. Jackson BJ. Source Slajacburdds@aol.com Erratum in

J Oral Implantol. 2003;29(6):314. Abstract Endosseous implant dentistry has become a predictable clinical modality. The role of the restorative dentist is to minimize overload to the crestal bone by utilizing implant occlusal principles. The prosthetic stages of treatment should follow a disciplined sequence. This article reviews occlusal principles and clinical applications for long-term success of endosseous implants.
J Can Dent Assoc. 2001 Oct;67(9):522-6. Occlusal stability in implant prosthodontics -- clinical factors to consider before implant placement. Saba S. Source saba@qc.aira.com Abstract The success of any prosthetic design depends on proper management of the occlusion. The clinical variables influencing occlusal stability must be determined and considered in the design of the final prosthesis. This paper outlines some of these variables. Br Dent J. 2002 Jan 26;192(2):79-88. Good occlusal practice in the provision of implant borne prostheses. Davies SJ, Gray RJ, Young MP. Source University Dental Hospital of Manchester. stephen.j.davies@man.ac.uk Abstract The increased use of endosseous dental implants means that many dentists will encounter patients with dental implants in their everyday practice. Dental practitioners might be actively involved in the provision of implant borne prostheses at both the surgical and restorative phases, or only at the restorative stage. This section is written for all dentists and aims to examine the subject of occlusion within implantology. It aims to provide guidelines of good occlusal practice to be used in the design of the prosthesis that is supported or retained by one or more implants. As implantology is a 'new' discipline of dentistry, there are fewer standard texts and this section, therefore, is much more extensively referenced than the subjects that have been considered to date. J Calif Dent Assoc. 2000 Oct;28(10):771-9. Occlusal considerations for implant restorations in the partially edentulous patient.

Curtis DA, Sharma A, Finzen FC, Kao RT. Source UCSF School of Dentistry, Department of Preventive and Restorative Dental Sciences, 707 Parnassus Ave., San Francisco, CA 94143-0758, USA. Abstract The type and frequency of complications associated with dental implants has changed during the past decade. As moresuccessful rates of osseointegration have resulted from improved surgical protocols and materials, the major complications have become restorative-related rather than surgery-related. Recent studies indicate that restorative complications with implant-retained restorations occur at rates of 10 percent to 77 percent over a three-year period. Many of the restorative complications can be minimized with careful treatment planning and coordination of care. However, because implants lack the stress release associated with a periodontal ligament, impact loading to restorative materials and the crestal bone remains potentially more damaging with implant-supported restorations. This article discusses the biomechanical implications of implant restorations and outlines occlusal considerations designed to decrease restorative complications. Journal of Prosthetic Dentistry Volume 81, Issue 5 , Pages 553561, May 1999 Toward an understanding of implant occlusion and strain adaptive bone modeling and remodeling Presented at Academy of Prosthodontics meeting, Colorado Springs, Colo., May 1998. Clark M. Stanford, DDS, PhDa, Richard A. Brand, MDb University of Iowa, Iowa City, Iowa aAssociate Professor, Dows Institute for Dental Research, College of Dentistry. bProfessor, Department of Orthopaedic Surgery, College of Medicine Abstract Statement of problem. Dental implant failure rates for osseointegration are greater in the highly atrophic maxilla. Presuming higher failure rates relate to strain-driven adaptation, an enhanced understanding of formative bone response to loading (modeling) and maintenance of an integrated state (remodeling) should improve treatment. Purpose. To understand the role of occlusal loading on longterm osseointegration in areas of compromised cancellous bone, a review of the salient features of adaptive bone modeling and remodeling is presented with an emphasis on cancellous bone responses. Conclusions. The ability for dental implants to maintain a long-term stable interface in the maxilla lies in the ability of trabecular bone to maintain adequate local material (strength) and architectural (connectivity) properties. In this discussion, an emphasis has been placed on understanding how trabecular bone can respond to the mastication-induced loading environment on an implant. (J Prosthet Dent 1999;81:553-61.) Occlusion on implants - is there a problem? Klineberg IJ, Trulsson M, Murray GM. J Oral Rehabil. 2012 Jul;39(7):522-37. doi: 10.1111/j.13652842.2012.02305.x. Epub 2012 Apr 17. Review. PMID: 22506541 [PubMed - indexed for MEDLINE] Related citations 2. Effects of occlusal inclination and loading on mandibular bone remodeling: a finite element study. Rungsiyakull C, Rungsiyakull P, Li Q, Li W, Swain M. Int J Oral Maxillofac Implants. 2011 May-Jun;26(3):527-37. PMID: 21691599 [PubMed - indexed for MEDLINE] Related citations 3. The influence of occlusal loading location on stresses transferred to implant-supported prostheses and supporting bone: A three-dimensional finite element study. Eskitascioglu G, Usumez A, Sevimay M, Soykan E, Unsal E. J Prosthet Dent. 2004 Feb;91(2):144-50. PMID: 14970760 [PubMed - indexed for MEDLINE] Related citations 4. Loading of a single implant in simulated bone.

Rungsiyakull P, Rungsiyakull C, Appleyard R, Li Q, Swain M, Klineberg I. Int J Prosthodont. 2011 Mar-Apr;24(2):140-3. PMID: 21479281 [PubMed - indexed for MEDLINE] Related citations 5. Immediate occlusal loading of Brnemark System TiUnite implants placed predominantly in soft bone: 4-year results of a prospective clinical study. Glauser R, Ruhstaller P, Windisch S, Zembic A, Lundgren A, Gottlow J, Hmmerle CH. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S52-9. PMID: 16137088 [PubMed - indexed for MEDLINE] Related citations 6. Evaluation of stress induced by implant type, number of splinted teeth, and variations in periodontal support in toothimplant-supported fixed partial dentures: a non-linear finite element analysis. Lin CL, Wang JC, Chang SH, Chen ST. J Periodontol. 2010 Jan;81(1):121-30. doi: 10.1902/jop.2009.090331. PMID: 20059424 [PubMed - indexed for MEDLINE] Related citations 7. The effect of implant diameter, restoration design, and occlusal table variations on screw loosening of posterior singletooth implant restorations. Bakaeen LG, Winkler S, Neff PA. J Oral Implantol. 2001;27(2):63-72. PMID: 12498429 [PubMed - indexed for MEDLINE] Related citations 8. Restoration of partially edentulous patients using dental implants with a microtextured surface: a prospective comparison of delayed and immediate full occlusal loading. Cannizzaro G, Leone M. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):512-22. PMID: 12939002 [PubMed - indexed for MEDLINE] Related citations 9. Implant-supported fixed prostheses for the rehabilitation of periodontally compromised dentitions: a 3-year prospective clinical study. Yi SW, Ericsson I, Kim CK, Carlsson GE, Nilner K. Clin Implant Dent Relat Res. 2001;3(3):125-34. PMID: 11799702 [PubMed - indexed for MEDLINE] Related citations 10. Biomechanical interactions in tooth-implant-supported fixed partial dentures with variations in the number of splinted teeth and connector type: a finite element analysis. Lin CL, Wang JC, Chang WJ. Clin Oral Implants Res. 2008 Jan;19(1):107-17. Epub 2007 Oct 16. PMID: 17944965 [PubMed - indexed for MEDLINE] Related citations 11. Photoelastic stress analysis of load transfer to implants and natural teeth comparing rigid and semirigid connectors. Nishimura RD, Ochiai KT, Caputo AA, Jeong CM. J Prosthet Dent. 1999 Jun;81(6):696-703. PMID: 10347358 [PubMed - indexed for MEDLINE] Related citations 12.

The influence of occlusal design on simulated masticatory forces transferred to implant-retained prostheses and supporting bone. Kaukinen JA, Edge MJ, Lang BR. J Prosthet Dent. 1996 Jul;76(1):50-5. PMID: 8814635 [PubMed - indexed for MEDLINE] Related citations 13. Photoelastic stress analysis of implant-tooth connected prostheses with segmented and nonsegmented abutments. Ochiai KT, Ozawa S, Caputo AA, Nishimura RD. J Prosthet Dent. 2003 May;89(5):495-502. PMID: 12806328 [PubMed - indexed for MEDLINE] Related citations 14. Influence of prosthetic parameters on the survival and complication rates of short implants. Tawil G, Aboujaoude N, Younan R. Int J Oral Maxillofac Implants. 2006 Mar-Apr;21(2):275-82. PMID: 16634499 [PubMed - indexed for MEDLINE] Related citations 15. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Gross MD. Aust Dent J. 2008 Jun;53 Suppl 1:S60-8. doi: 10.1111/j.18347819.2008.00043.x. Review. PMID: 18498587 [PubMed - indexed for MEDLINE] Related citations 16. Immediate occlusal loading of Brnemark TiUnite implants placed predominantly in soft bone: 1-year results of a prospective clinical study. Glauser R, Lundgren AK, Gottlow J, Sennerby L, Portmann M, Ruhstaller P, Hmmerle CH. Clin Implant Dent Relat Res. 2003;5 Suppl 1:47-56. PMID: 12691650 [PubMed - indexed for MEDLINE] Related citations 17. Osseoperception: sensory function and proprioception. Klineberg I, Murray G. Adv Dent Res. 1999 Jun;13:120-9. Review. PMID: 11276734 [PubMed - indexed for MEDLINE] Related citations 18. Immediate loading using cross-arch fixed restorations in heavy smokers: nine consecutive case reports for edentulous arches. Romanos GE, Nentwig GH. Int J Oral Maxillofac Implants. 2008 May-Jun;23(3):513-9. PMID: 18700376 [PubMed - indexed for MEDLINE] Related citations 19. Retrospective evaluation of complete-arch fixed partial dentures connecting teeth and implant abutments in patients with normal and reduced periodontal support. Cordaro L, Ercoli C, Rossini C, Torsello F, Feng C. J Prosthet Dent. 2005 Oct;94(4):313-20. PMID: 16198167 [PubMed - indexed for MEDLINE] Related citations 20. Sensory and motor function of teeth and dental implants: a basis for osseoperception. Trulsson M. Clin Exp Pharmacol Physiol. 2005 Jan-Feb;32(1-2):119-22. Review. PMID:

15730446 [PubMed - indexed for MEDLINE] Related citations