Corticalization around dental implants: A narrative review of the literature

Abstract

Objectives

Dental implants are widely used for tooth replacement, contributing to both aesthetics and functionality. This narrative review examines the peri-implant corticalization phenomenon—the transformation of trabecular bone to cortical bone around implants following functional loading—and explores its impact on implant longevity.

Methods

A systematic search across databases including MEDLINE, Web of Science, Google Scholar, EMBASE, Scopus, and the Cochrane Library identified studies relevant to peri-implant corticalization post-implant loading. Studies were screened for relevance based on inclusion criteria, focusing on the influence of corticalization on implant success.

Results

Of 114 initially identified articles, 86 were screened, and 8 met full inclusion criteria. The review highlights corticalization as a significant factor in peri-implant bone remodeling, frequently linked with marginal bone loss (MBL). Factors influencing corticalization include patient-specific aspects (e.g., smoking, body mass index [BMI], hormone levels), implant design (e.g., thread type, placement depth), and prosthetic choices (e.g., single crowns vs. bridges). Notably, higher corticalization is associated with increased MBL, potentially compromising implant stability. Implants with design features like microthreads or apical grooves, subcrestal placement, and lower insertion torque show reduced corticalization, thereby enhancing long-term outcomes.

Conclusion

Peri-implant corticalization, while an adaptive bone remodeling response to implant loading, is associated with adverse outcomes, including MBL and potential implant failure over time. Implant design, patient health, and placement techniques play critical roles in modulating corticalization, underscoring the need for targeted clinical planning to enhance implant success. This review advocates for further research to clarify corticalization’s long-term impact and refine implant protocols for improved patient outcomes.