Bone Metabolism and Dental Implant Insertion as a Correlation Affecting on Marginal Bone Remodeling: Texture Analysis and the New Corticalization Index, Predictor of Marginal Bone Loss-3 Months of Follow-Up.

Background/Objectives: The general condition of implantology patients is crucial when considering the long- and short-term survival of dental implants. The aim of the research was to evaluate the correlation between the new corticalization index (CI) and patients' condition, and its impact on marginal bone loss (MBL) leading to implant failure, using only radiographic (RTG) images on a pixel level. Method: Bone near the dental implant neck was examined, and texture features were analyzed. Statistical analysis includes analysis of simple regression where the correlation coefficient (CC) and R2 were calculated. Detected relationships were assumed to be statistically significant when p < 0.05. Statgraphics Centurion version 18.1.12 (Stat Point Technologies, Warrenton, VA, USA) was used to conduct the statistical analyses. Results: The research revealed a correlation between MBL after 3 months and BMI, PTH, TSH, Ca2+ level in blood serum, phosphates in blood serum, and vitamin D. A correlation was also observed between CI and PTH, Ca2+ level in blood serum, vitamin D, LDL, HDL, and triglycerides on the day of surgery. After 3 months of the observation period, CI was correlated with PTH, TSH, Ca2+ level in blood serum, and triglycerides. Conclusion: The results of the research confirm that the general condition of patients corresponds with CI and MBL. A patient's general condition has an impact on bone metabolism around dental implants. Implant insertion should be considered if the general condition of the patient is not stable. However, CI has not yet been fully investigated. Further studies are necessary to check and categorize the impact of corticalization on marginal bone loss near dental implants.

New Radiological Corticalization Index as an Indicator of Implant Success Rate Depending on Prosthetic Restoration-5 Years of Follow-Up.

The new Radiological Corticalization Index (CI) is an indicator that describes bone remodeling near the dental implant's neck at the pixel level and is not visible to the naked eye. The aim of this research was to evaluate the correlation between the CI and bone remodeling using only radiographic (RTG) images. RTG samples were divided into groups depending on prosthetic restoration; the implant neck area around dental implants was examined, and texture features of the RTG images were analyzed. The study also investigated the type of prosthetic restoration and its influence as a factor on bone structure. The statistical analysis included evaluating feature distribution, comparing means (t-test) or medians (W-test), and performing a regression analysis and one-way analysis of variance or the Kruskal-Wallis test, as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Differences or relationships were considered statistically significant at p < 0.05. The research revealed correlations between single crowns, overdenture restoration, bridge restoration, platform switching, prosthetic fracture, CI, and also marginal bone loss where p was lower than 0.05. However, the corticalization phenomenon itself has not yet been fully explored. The findings suggest that, depending on the type of prosthetic restoration, the corticalization index may correlate with marginal bone loss or not. Further research is necessary, as the index is suspected to not be homogeneous.

Maxillofacial Microvascular Free-Flap Reconstructions in Pediatric and Young Adult Patients-Outcomes and Potential Factors Influencing Success Rate.

Background: Maxillofacial microvascular free-flap reconstructions are significant interventions in the management of congenital defects, traumatic injuries, malignancies, and iatrogenic complications in pediatric and young adult patients. Craniofacial disorders within this demographic can result in profound functional, cosmetic, and psychosocial impairments, highlighting the critical need for thorough investigation into factors that may influence procedural success and postoperative quality of life. This retrospective chart review aims to examine the outcomes and potential influencing factors, aiming to offer valuable insights into optimizing the effectiveness of these reconstructions and improving patient outcomes. Methods: A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender, and etiology of defect were determined using the ANOVA test and χ2 test of independence. Results: The results indicate a 90% success rate. No significant relationship was found between the incidence of total flap loss and patient age, etiology, or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular reconstructions (11 vs. 3 cases). Conclusions: Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and young adult patients.

Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options.

(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25-45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate's mechanical force, surpassing the conventional Plate Design Factor (PDF).

Finite Element Analysis of Subperiosteal Implants in Edentulism-On the Basis of the MaI Implant® by Integra Implants®.

The MaI Implants® method offers a modern treatment option for specific patients who lack sufficient bone for traditional screw-based implants. The aim of the article is to use Finite Element Analysis (FEA) to examine the behavior of a subperiosteal implant under actual conditions within the oral cavity and to assess the impact of various mechanical factors on the durability of the MaI Implants®. A strength analysis was conducted using Finite Element Analysis for two models. The first was a single subperiosteal implant, while the second was a model of an arch consisting of two single subperiosteal implants connected by a bar. Based on the obtained results, it can be observed that the increase in load from 100 N to 800 N leads to an increase in displacements throughout the implant. Changing the angle from 90 to 30 degrees resulted in a 576% increase in the average displacement value across all multi-units. Stresses in the multi-units range from 23.7 MPa to 268.5 MPa. The lack of proper stabilization of the implant has the greatest impact on the results of displacements. Such displacements are significant for the later positioning of the implant compared to the initial conditions.

Which of the 37 Plates Is the Most Mechanically Appropriate for a Low-Neck Fracture of the Mandibular Condyle? A Strength Testing.

(1) Background: The mandible is the most frequently injured component of the facial skeleton, with 25-45% of mandibular fractures involving the condylar process. This study aims to mechanically compare which plates are most suitable for use in low-neck fractures of the condyle. (2) Methods: Polyurethane mandibular models with simulated low-neck fractures were tested using 37 distinct plate designs. These plates were fabricated from 1 mm thick, grade 23 titanium sheets. The models were then subjected to force tests on a strength machine, and the correlation between applied force and fracture displacement was recorded. (3) Results: For low-neck fractures, XCP side-dedicated 3+5 and ACP-T plates demonstrated strength comparable to that of two straight plates, the current gold standard in osteosynthesis. (4) Conclusions: The Mechanical Excellence Factor (MEF) introduced by the authors provides a more accurate metric for theoretically predicting a plate's mechanical strength compared to the Plate Design Factor (PDF). Eight plate characteristics were utilized to calculate the MEF. Employing the MEF allows for rapid, preliminary validation before undertaking strength tests. Furthermore, the findings of this study can guide the selection of the most durable plate designs for subsequent fatigue testing.

The Zygomatic Anatomy-Guided Approach, Zygomatic Orbital Floor Classification, and ORIS Criteria-A 10-Year Follow-Up.

BACKGROUND: Presently, the management of patients with maxilla bone defects of the Cawood V or VI class is achieved using zygomatic or individual implants or through augmentation of the bone. For zygomatic implants, the ORIS criteria represent the most common factor in helping practitioners register success rates. The zygomatic anatomy-guided approach (ZAGA)and zygomatic orbital floor (ZOF) are factors that are crucial to examining the anatomy of a particular patient before the procedure. The aim of thisarticle is to find the statistical relationship between the abovementioned terms and other factors. METHODS: A total of 81 patients underwent zygomatic implant procedures in different configurations. The ORIS, ZAGA, and ZOF parameters were compared with other factors such as type of surgery, sex, age, and the anatomy of the zygomatic bone. RESULTS: Most patients in this article were classified as ZAGA Class 2. The relationships between type of surgery and ZAGA classification, and ZAGA and sinus/maxilla zygomatic implant localization were statistically significant. CONCLUSIONS: The ZAGA and ZOF scales are practical and valuable factors that should be taken into account before surgery, whereas to date, criteria better than the ORIS scale have not been described in terms of the success of zygomatic implants. The ZOF scale might omit perforation of the orbit because this parameter warns a practitioner to be aware of the anatomy of the orbit.

Oral Cavity Cancer Tissues Differ in Isotopic Composition Depending on Location and Staging.

The aim of this paper was to characterise the isotopic composition of oral squamous cell carcinoma (OSCC) specimens of different areas of the oral cavity. Secondly, we assessed whether there was a correlation between clinical stages of OSCC and isotopic abundance. The IRMS procedure was performed on 124 samples derived from 31 patients with OSCC of 15 N and 13 C to assess the isotopic composition. From each individual, four samples from the tumour, two from the margins, and two samples of healthy oral mucous membranes were derived. The two samples from the tumour and two samples from the margin were additionally subjected to histopathological assessment. Then, statistical analysis was conducted. Tumour infiltration tissues of the lower lip were characterised by higher mean δ13C values compared to samples derived from cancers of the other oral cavity regions (-23.82 ± 1.21 vs. -22.67 ± 1.35); (p = 0.04). The mean percentage of nitrogen content in tumour tissues was statistically higher in patients with the most advanced cancers (11.89 ± 0.03%) versus the group of patients with II and III stage cancers (11.12 ± 0.02%); (p = 0.04). In patients at stage IV, the mean δ13C value in the cancer samples equalled -22.69 ± 1.42 and was lower than that in patients at less severe clinical stages (p = 0.04). Lower lip cancer tissues differed in the isotopic abundance of carbon in comparison with tissues derived from the group of combined samples from other locations. Values of δ13C observed in specimens derived from lower lip cancers were similar to those observed in healthy oral mucous membranes. Cancer tissues obtained from patients in the last stage of OSCC had a different isotopic composition in comparison with those obtained from earlier stages. To confirm these observations, further research on larger groups of patients is needed.

Is Corticalization in Radiographs Related to a Higher Risk of Bone Loss around Dental Implants in Smoking Patients? A 5-Year Observation of Radiograph Bone-Texture Changes.

BACKGROUND: Currently, the topic of dental implants is widely researched. However, still compromising are the factors that can affect implant loss as a consequence of marginal bone loss. One of the factors is smoking, which has a devastating effect on human health and bone structure. Oral health and jaw condition are also negatively affected by smoking. The aim of this study was to evaluate the peri-implant jawbone corticalization phenomenon in tobacco smokers. METHODS: A total of 2196 samples from 768 patients with an implant in the neck area were checked, and texture features were analyzed. The corticalization phenomenon was investigated. All analyses were performed in MaZda Software. The influence of corticalization was investigated as a factor on bone structure near the implant neck. The statistical analysis included a feature distribution evaluation, mean (t-test) or median (W-test) comparison, analysis of regression and one-way analysis of variance or Kruskal-Wallis test as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Detected differences or relationships were assumed to be statistically significant when p < 0.05. RESULTS: The research revealed that MBL was correlated with smoking after 5 years (0.42 mm ± 1.32 mm 0 mm ± 1.25 mm), the Corticalization Index was higher in the smoker group on the day of surgery, and it became higher after 5y of observation (185.98 ± 90.8 and 243.17 ± 155.47). The implant-loss frequency was higher in the group of smokers, too, compared to non-smokers (6.74% and 2.87%). The higher the torque value during the implant placement, the higher the Corticalization Phenomenon Index. CONCLUSIONS: The research revealed a correlation between smoking and changes in bone structure in radio textures near the implants. The corticalization phenomenon is important, may be detected immediately after implant placement and may be one of the indicators of the implant success rate.

Lateral Pterygoid Muscle Alteration in Patients Treated Surgically Due to Mandibular Head Fractures.

The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular head fractures and the impact of this change on the range of motion of the mandible. Another issue addressed is the persistence of changes in the appearance of the lateral pterygoid muscles after surgical treatment. In this study, 66 patients with unilateral mandibular head fracture were included. An additional 15 patients from this group who were treated only conservatively were separated as an extra reference group to exclude completely the effect of surgery on the appearance of the pterygoid lateral muscle (even on the opposite side to the surgically treated side). The range of mandibular movements was measured at specific time intervals up to 24 months post-operationally. Then, the lengths and widths of the lateral pterygoid muscles on the operated and healthy site were measured in CT images. The results were compared with a control group which consisted of muscles of the intact site (opposite site to the fracture). A significant reduction in the length-to-width ratio of the lateral pterygoid muscle on the operated side by approx. 20% is observed. This suggests that the muscle becomes more spherical, and thus the range of lateral movement to the contralateral side is permanently reduced.

Evaluation of the Relationship of Screw Pullout and Plate Fracutre in Fixation of Mandible Condyle Fractures: A Mechanistic Study.

BACKGROUND: The mandible is the most injured part of the facial skeleton, and 25-40% of mandibular fractures involve the condyle process. The aim of this study is to answer the question of the relationship between screw pullout and/or plate fracture during osteosynthesis. METHODS: We tested polyurethane models of mandibles whose condylar process was cut (simulating a fracture) and fused using plates and screws. RESULTS: A total of 672 plates were tested. A total of 25.6% of them were fractured during the test, with most being fractures of the base of the condyle. More screws (81.97%) are pulled out from the ramus than from the condyle-69.15%. CONCLUSIONS: The gold standard in the osteosynthesis of condylar fractures is two straight plates. Other than these, there is no one-size-fits-all plate for every type of fracture. Plates fixed with fewer screws (smaller plates used in higher-lying fractures) are more likely to result in screw pullout. On the other hand, in plates fixed with more screws, plate fracture is more common.

Which of 51 Plate Designs Can Most Stably Fixate the Fragments in a Fracture of the Mandibular Condyle Base?

In the surgical treatment of the most common fracture of the mandible, which is a fracture of the condylar base, a great choice of different plate shapes is observed. The aim of this study was to determine which shape gives the greatest fixation stiffness. To ensure homogeneity in comparison, tests were performed on polyurethane models divided at the level of the condylar base fracture and each were fixed with 51 plates. The plates were cut from a 1 mm thick grade 23 titanium sheet. The models were then loaded and the force required for 1 mm of fracture displacement was recorded. It was noted that in addition to osteosynthesis from two simple plates, there were also two dedicated single plates with similar rigidity. Among the large number of described designs of plates, there is considerable variation in terms of the stability of the fixation performed with them. The proposed Mechanical Excellence Factor allows a pre-evaluation of the expected rigidity of fixation with a given plate shape without the need for a loading experiment. The authors expect this to be helpful for surgeons in the application of relevant plates, as well for inventors of new plates for the osteosynthesis of basal fractures in mandibular condyle.

Mechanical Properties, Fractal Dimension, and Texture Analysis of Selected 3D-Printed Resins Used in Dentistry That Underwent the Compression Test.

Three-dimensional printing is finding increasing applications in today's world. Due to the accuracy and the possibility of rapid production, the CAD/CAM (computer-aided design/computer-aided manufacturing) technology has become the most desired approach in the preparation of elements, especially in medicine and dentistry. This study aimed to compare the biomechanical properties, fractal dimension (FD), and texture of three selected materials used for 3D printing in dentistry. Three biomaterials used in 3D printing were evaluated. The materials were subjected to the compression test. Then, their mechanical features, FD, and texture were analyzed. All the tested materials showed different values for the studied properties. The only statistically insignificant difference was observed for the force used in the compression test. All three materials showed differences in width and height measurements. The difference in the decrease between the compression plates was also significant. For Dental LT Clear, the mean value was 0.098 mm (SD = 0.010), while for BioMed Amber it was 0.059 mm (SD = 0.019), and for IBT it was 0.356 mm (SD = 0.015). The nominal strain also differed between the materials. IBT had the highest mean value (7.98), while BioMed Amber had the smallest (1.31). FD analysis revealed that Dental LT Clear did not show differences in the structure of the material. The other two materials showed significant changes after the compression test. Texture analysis (TA) revealed similar results: BioMed Amber resin showed significantly less pronounced texture changes compared to the other two materials. BioMed Amber also showed the most stable mechanical properties, whereas those of IBT changed the most. Fractal analysis revealed that IBT showed significant differences from the other two materials, whereas TA showed that only Dental LT Clear did not show changes in its texture after the compression test. Before the compression, however, BioMed Amber differed the most when bone index was taken into account.

An Experimental Anodized and Low-Pressure Oxygen Plasma-Treated Titanium Dental Implant Surface-Preliminary Report.

Chemical composition and physical parameters of the implant surface, such as roughness, regulate the cellular response leading to implant bone osseointegration. Possible implant surface modifications include anodization or the plasma electrolytic oxidation (PEO) treatment process that produces a thick and dense oxide coating superior to normal anodic oxidation. Experimental modifications with Plasma Electrolytic Oxidation (PEO) titanium and titanium alloy Ti6Al4V plates and PEO additionally treated with low-pressure oxygen plasma (PEO-S) were used in this study to evaluate their physical and chemical properties. Cytotoxicity of experimental titanium samples as well as cell adhesion to their surface were assessed using normal human dermal fibroblasts (NHDF) or L929 cell line. Moreover, the surface roughness, fractal dimension analysis, and texture analysis were calculated. Samples after surface treatment have substantially improved properties compared to the reference SLA (sandblasted and acid-etched) surface. The surface roughness (Sa) was 0.59-2.38 µm, and none of the tested surfaces had cytotoxic effect on NHDF and L929 cell lines. A greater cell growth of NHDF was observed on the tested PEO and PEO-S samples compared to reference SLA sample titanium.

Current Frequency of Mandibular Condylar Process Fractures.

There are significant discrepancies in the reported prevalence of condylar process fractures among all mandibular fractures (16.5-56%) in the available literature. In addition, it seems that the actual number of difficult-to-treat fractures of the mandibular head is unknown. The purpose of this study is to present the current incidence of the different types of mandibular process fractures with a special focus on mandibular head fractures. The medical records of 386 patients with single or multiple mandibular fractures were reviewed. Of the fractures found, 58% were body fractures, 32% were angle fractures, 7% were ramus fractures, 2% were coronoid process fractures, and 45% were condylar process fractures. The most common fracture of the condylar process was a basal fracture (54% of condylar fractures), and the second most common fracture was a fracture of the mandibular head (34% of condylar process fractures). Further, 16% of patients had low-neck fractures, and 16% had high-neck fractures. Of the patients with head fractures, 8% had a type A fracture, 34% had a type B fracture, and 73% had a type C fracture. A total of 89.6% of the patients were surgically treated with ORIF. Mandibular head fractures are not as rare as previously thought. Head fractures occur twice as often in the pediatric population than in adults. A mandibular fracture is most likely related to a mandible head fracture. Such evidence can guide the diagnostic procedure in the future.

Exploring the Importance of Corticalization Occurring in Alveolar Bone Surrounding a Dental Implant.

Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants such transformations occur in the bone directly adjacent to the fixture. Intuitively, it seems that this is a process conducive to the long-term maintenance of dental implants and certainly necessary when immediate loading is applied. The authors examined the relationship of implant design features to marginal bone loss (MBL) and the intensity of corticalization over a 10-year period of functional loading. This study is a general description of the phenomenon of peri-implant bone corticalization and an attempt to interpret this phenomenon to achieve success of implant treatment in the long term. Corticalization significantly increased over the first 5-year functional loading (CI from 200 ± 146 initially to 282 ± 182, p < 0.001) and maintained a high level (CI = 261 ± 168) in the 10-year study relative to the reference bone (149 ± 178). MBL significantly increased throughout the follow-up period­5 years: 0.83 ± 1.26 mm (p < 0.001), 10 years: 1.48 ± 2.01 mm (p < 0.001). MBL and radiographic bone structure (CI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. In the scope of the study, it can be concluded that the phenomenon of peri-implant jawbone corticalization seems an unfavorable condition for the future fate of bone-anchored implants, but it requires further research to fully explain the significance of this phenomenon.

Measures of Corticalization.

After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction.

Surface Evaluation of Aligners after Immersion in Coca-Cola and Orange Juice.

Orthodontic removable appliances made of transparent thermoplastic materials-aligners-are becoming increasingly popular in contemporary orthodontic practice. It is important for the clinician to fully understand the mechanical properties and behavior of the appliance used. Because of that, the aim of our study was to investigate the changes in aligner surface after immersion in Coca-Cola and orange juice. For surface evaluation, fractal analysis, texture analysis, and wetting angle measurement were performed. Statistically significant changes were found between some of the groups in the fractal dimension analysis. In texture analysis, all but one intergroup comparison showed statistically significant differences. For wetting angle assessment, statistically significant differences were found. These were, however, more numerous when assessing glycol droplets, rather than water droplets. Fractal dimension analysis confirmed a correlation between the intensity of changes in the aligner surface with immersion time in the liquids assessed. Texture analysis showed a high sensitivity to the changes in aligner surface. It failed, however, to reveal changes relative to immersion time. Wetting angle analysis revealed aligner surface degradation for Coca-Cola. It did not, however, prove the dependence of the intensity of this degradation as a function of time. Both Coca-Cola and orange juice can cause aligner surface degradation.

Fractal Dimension Analysis of Melanocytic Nevi and Melanomas in Normal and Polarized Light-A Preliminary Report.

Clinical diagnosis of pigmented lesions can be a challenge in everyday practice. Benign and dysplastic nevi and melanomas may have similar clinical presentations, but completely different prognoses. Fractal dimensions of shape and texture can describe the complexity of the pigmented lesion structure. This study aims to apply fractal dimension analysis to differentiate melanomas, dysplastic nevi, and benign nevi in polarized and non-polarized light. A total of 87 Eighty-four patients with 97 lesions were included in this study. All examined lesions were photographed under polarized and non-polarized light, surgically removed, and examined by a histopathologist to establish the correct diagnosis. The obtained images were then processed and analyzed. Area, perimeter, and fractal dimensions of shape and texture were calculated for all the lesions under polarized and non-polarized light. The fractal dimension of shape in polarized light enables differentiating melanomas, dysplastic nevi, and benign nevi. It also makes it possible to distinguish melanomas from benign and dysplastic nevi under non-polarized light. The fractal dimension of texture allows distinguishing melanomas from benign and dysplastic nevi under polarized light. All examined parameters of shape and texture can be used for developing an automatic computer-aided diagnosis system. Polarized light is superior to non-polarized light for imaging texture details.

What Does Bone Corticalization around Dental Implants Mean in Light of Ten Years of Follow-Up?

The phenomenon of peri-implant bone corticalization after functional loading does not yet have a definite clinical significance and impact on prognosis. An attempt was made to assess the clinical significance of this phenomenon. This prospective study included 554 patients. Standardized intraoral radiographs documenting the jawbone environment of 1556 implants were collected. The follow-up period was 10 years of functional loading. Marginal alveolar bone loss (MBL) and radiographic bone structure (bone index, BI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. After five years, bone structure abnormalities expressed by a reduction of BI to 0.47 ± 0.21 and MBL = 0.88 ± 1.27 mm were observed. Both values had an inverse relationship with each other (p < 0.0001). Reference cancellous bone showed BI = 0.85 ± 0.18. The same relationship was observed after ten years of functional loading: BI = 0.48 ± 0.21, MBL = 1.49 ± 1.94 mm, and again an inverse relationship (p < 0.0001). Increasing corticalization (lower BI) is strongly associated with increasing marginal bone loss and increasing corticalization precedes future marginal bone loss. Marginal bone loss will increase as corticalization progresses.