Occlusione e malattia peri-implantare nella riabilitazione implanto-supportata

OBJECTIVES The purpose of this study is to provide a narrative review of occlusal principles applicable to implant-supported full-arch rehabilitations based on currently available data in the literature, with particular reference to the potential correlation between occlusion and peri-implant disease. MATERIALS AND METHODS This study aims to review scientific literature pertaining to the topic of implant-supported full-arch rehabilitations in terms of occlusion, occlusal scheme, occlusal material, and potentially occlusion-related biological complications with special reference to peri-implant disease. The search was conducted using the PubMed/MEDLINE database. The results are presented in a narrative review of the literature aimed at providing practical clinical recommendations for the management of occlusion in implant-supported full-arch prostheses based on currently available data on the topic. RESULTS In implant-supported full-arch rehabilitations, the absence of periodontal ligament mechanoreceptors may result in increased susceptibility to occlusal overload. Occlusal overload, in addition to being a cause of mechanical implant-prosthetic complications, can be considered a potential accelerating factor for peri-implant disease in the presence of plaque and inflammation. Implant-prosthetic occlusion aims to minimize occlusal overloads and confers mechanical and biological stability. In implant-supported rehabilitations, the type of occlusion must be decided on the basis of several factors capable of conditioning the loads on prostheses and implants, and occlusal patterns are chosen according to the antagonist arch. The cantilever is a cause of biomechanical stress and should be sized according to precise parameters. Bruxism is considered to contribute significantly to implant fracture and peri-implant bone loss. There appears to be no difference between occlusal materials in terms of stress transmitted to implants and bone. CONCLUSIONS The relationship between occlusion and peri-implant disease is a complex issue that in implant-supported rehabilitations involves several factors including prosthetic design and occlusal scheme. The lack of scientific evidence, however, does not allow a causal link to be clarified. In full-arch implant-supported prosthetics, decreased proprioceptive feedback requires special attention to biomechanical factors: minimizing overload complications and conferring biomechanical stability are among the main goals of implant-supported occlusion. The choice of occlusal scheme should be defined according to the type of antagonist arch according to criteria of advantageous load distribution. Cantilever and bruxism are considered potential causes of peri-implant bone loss: they represent the most critical biomechanical stressors and require occlusal strategies aimed at defusing unfavorable forces. The choice of occlusal material seems to be irrelevant in terms of transmission of forces to implants and peri-implant bone. CLINICAL SIGNIFICANCE Despite the great popularity of implantology, a low level of scientific evidence persists on how to manage occlusion in cases of implant-prosthetic rehabilitations. Occlusion decisions should be aimed at providing as little biomechanical stress as possible to the implant-prosthesis. For this reason, each case must be evaluated individually and needs individualized planning. Despite the ambiguous nature of the link between occlusal overload and peri-implant disease, the occurrence of mechanical complications should be attended to because they can be the prelude to biological complications and vice-versa.