Toward an understanding of implant occlusion and strain adaptive bone modeling and remodeling

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 long-term 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 bane 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.