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Volume 71 Number 4
T
he existence of the biologic width
at the implant-abutment interface and to determine if this lat-
around teeth has been documented
eral dimension has an effect on the height of the crest of bone
in the literature. It was a study by
between adjacent implants separated by different distances.
Gargiulo et al.1 in 1961 that gave us a
Methods: Radiographic measurements were taken in 36
dimensional understanding of this physio-
patients who had 2 adjacent implants present. Lateral bone loss
logic attachment apparatus. The average
was measured from the crest of bone to the implant surface. In
distance from the base of the sulcus to the
addition, the crestal bone loss was also measured from a line
crest of the bone was found to be 2.04 mm.
drawn between the tops of the adjacent implants. The data were
The epithelial attachment averaged 0.97
divided into 2 groups, based on the inter-implant distance at
mm and the connective tissue attachment
the implant shoulder.
averaged 1.07 mm in length. Another
Results: The results demonstrated that the lateral bone loss
cadaver study by Vacek et al.2 in 1994 con-
was 1.34 mm from the mesial implant shoulder and 1.40 mm
firmed the consistency of these dimensions
from the distal implant shoulder between the adjacent implants.
while showing the connective tissue attach-
In addition, the crestal bone loss for implants with a greater than
ment to average 0.77 mm and the epithe-
3 mm distance between them was 0.45 mm, while the implants
lial attachment to average 1.14 mm.
that had a distance of 3 mm or less between them had a cre-
The presence of a biologic width around
stal bone loss of 1.04 mm.
implants has also been investigated. Multiple
Conclusions: This study demonstrates that there is a lateral
research groups have verified that a biologic
component to the bone loss around implants in addition to the
width also exists around implants.3-8 This is
more commonly discussed vertical component. The clinical sig-
true for implants of all shapes after uncov-
nificance of this phenomenon is that the increased crestal bone
ering (stage 2) surgery. For 1-piece non-sub-
loss would result in an increase in the distance between the base
merged implants4,7,8 or 2-stage implants
of the contact point of the adjacent crowns and the crest of
used with a single-stage non-submerged pro-
bone. This could determine whether the papilla was present or
tocol, the biologic width will form at the time
absent between 2 implants as has previously been reported
of implant placement. This phenomenon is
between 2 teeth. Selective utilization of implants with a smaller
not related to loading and it will occur
diameter at the implant-abutment interface may be beneficial
whether the implant is unloaded or loaded.7
when multiple implants are to be placed in the esthetic zone so
The biologic rationale is that the bone
that a minimum of 3 mm of bone can be retained between them
exposed to the oral cavity will always cover
at the implant-abutment level. J Periodontol 2000;71:546-549.
itself with periosteum and connective tissue.
KEY WORDS Additionally, connective tissue will always
Dental implants; dental implantation; bone loss; alveolar bone; cover itself with epithelium. If a chronic irri-
papilla. tant, such as bacteria, reaches the implant-
abutment interface through screw-access
channels,9-12 or if the abutment is removed
* Department of Implant Dentistry, New York University College of Dentistry, New York, NY.
after initial healing,6 the bone will resorb to
create a distance from this chronically
exposed or irritated area. Tarnow et al.13 have
previously histologically documented a sim-
ilar bone response to subgingival crown
preparations that violate the attachment
apparatus on human teeth.
546
9046_IPC_AAP_553150 4/20/00 3:19 PM Page 547
Figure 1.
Radiographic measurements recorded. A and B represent the lateral Figure 2.
distance (bone loss) from the implant to bone crest; C, vertical crestal Inter-implant distance greater than 3 mm. Lateral bone loss from
bone loss; and D, the distance between implants at the implant- adjacent implants (A and B from Figure 1) does not overlap, with
abutment interface. minimal resultant crestal bone loss (C from Figure 1).
547
9046_IPC_AAP_553150 4/20/00 3:20 PM Page 548
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