CLINICAL RESEARCH

Interproximal contact loss in a retrospective cross-sectional

study of 4325 implants: Distribution and incidence and the
effect on bone loss and peri-implant soft tissue
David French, DDS, Dip Perio,a Mitchel Naito, BSc, DDS,b and Bernie Linke, DDS, MSDc

Dental implants are a success- ABSTRACT

ful means of replacing missing
Statement of problem. Interproximal contact loss (ICL) is a common finding between implant
teeth but are not without com- restorations and teeth, yet few reports have been published on incidence or related complications.
plications, with both biological
and technical complications Purpose. The purpose of this cross-sectional retrospective study was to measure the ICL of 4325
1 implants, including single and multiple splinted restorations.
reported. Teeth suspended by
the periodontal ligament can Material and methods. Data on 4325 implants were extracted from patient records on ICL, time of
move in relation to force vectors follow-up, implant location, and sex of the participant for whom implants were placed in a private
related to the cusp angle and practice between 1999 and 2016. Periapical radiographs were used to evaluate the crestal bone
level (CBL), whereas peri-implant soft tissues were evaluated with the implant mucosal index (IMI).
root tip, tooth wear, and other
Measurements (ICL, IMI, and CBL) were evaluated with an average follow-up of 4.5 years (range: 0.25
factors; in addition, the under- to 21 years). ICL was assessed in relation to the implant location and sex and grouped by the last
lying alveolar bone structure clinical recall (1, 2-3, 4-5, 6-7, or 8+ years) to evaluate the effect of time. Data were analyzed by the
itself can move. This can lead to chi-square test (a=.05).
relative malpositioning of an Results. Overall, 17% of implants had ICL, and this significantly increased over time from 11% at 1
osseointegrated dental implant, year to 29% at 8 years (chi-square: 123.8, P<.001). Mandibular implants had more ICL (20%) than
which is in effect an ankylosed maxillary implants (15%) (chi-square: 17.5, P<.001), whereas no difference was found between molar
medical device.2 Despite the and premolar sites or male and female participants. There was no significant effect of ICL on CBL
potential for interproximal over time, but there was an increase in inflammation with higher IMI scores at ICL sites.
contact loss (ICL) between im- Conclusions. The incidence of implant ICL was found to be 17%, and ICL was found to increase
plants and adjacent teeth, few over time up to 27% at 8 years of follow-up. ICL was more common in posterior and mandibular
reports have been published. A sites. ICL was shown to increase soft tissue inflammation but was not found to affect implant
review in 20153 found only 5 CBLs. (J Prosthet Dent 2019;-:---)
articles on the topic of open
proximal contacts but reported complications in a reported evaluating open contact in 28 participants with 55 pros-
range of between 34% and 66% of implant-supported theses using 3D occlusal imaging.5 In one of the earliest
crowns, occurring most often at mesial sites and soon af- studies on the topic, a 5-year study of 49 Brånemark
ter restoration. single-tooth implants, 33% of implant sites had open
The inherent mesial tipping of teeth may lead to ICL mesial contact and 17% had open distal contact, sug-
adjacent to implants,4 in relation to mesial drift, root gesting that the cusp angle or other factors may also be
angle, and high occlusal forces as shown by a study involved.6 A more recent cross-sectional retrospective

a
Clinical Instructor, Faculty of Dentistry, Department of Periodontics, University of British Columbia Faculty of Dentistry, Vancouver, Canada; and Private practice, Calgary,
Canada.
b
Graduate Resident, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Canada.
c
Director, Department of Prosthodontics, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Canada.

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and because the implant-supported dentures or

Clinical Implications complete-arch prostheses or the implant restoration was
Interproximal contact loss increases with time and adjacent to a diastema.
Data were extracted from the electronic patient chart
may demand increasing clinical time for correction.
and entered into a spreadsheet. Participant information
This complication was commonly found mesial to
was recorded with a unique identifier for anonymity. The
the implant and posterior in the arch. Interproximal
data were evaluated for the effect of time, sex of the
contact loss did not affect the crestal bone level, but
participant, and implant location on the incidence of ICL
an increase in mucositis and the potential for caries
adjacent to dental implant-supported crown or fixed
adjacent to the fixed implant restoration were
partial denture restorations. An analysis was also per-
noted.
formed as to whether the tissue tone and bone level were
affected by ICL. Statistical analysis was performed with
the chi-square test and repeated measures ANOVA by
study of 174 single-implant posterior and anterior res-
using a statistical software program (IBM SPSS Statistics,
torations, followed up between 3 months and 11 years,
v24; IBM Corp) (a=.05).
reported 52.8% open contacts with a distribution of
Implants were inserted according to manufacturer’s
78.2% at mesial surfaces versus 21.8% at distal surfaces;
guidelines and indications. All potential implant loca-
the study also noted that participants were often aware of
tions were used, and the location of each implant was
related food impaction.7 Despite some reports noting
determined based on individual participant’s needs and
that ICL can occur as early as 3 months after restoration,
prosthetic requirements; no set location or group of lo-
the effect of time has not yet been well established.3
cations were planned or declined. All participants had a
Given the range in results, further studies of ICL,
periodontal screening examination; if active periodontal
including the relation to implant position and time, are
disease was present, it was treated before dental implant
warranted. Most studies report on proximal contact loss
surgery. Patient education and consent to implant sur-
for single-implant crowns, so the inclusion of multiple
gery was obtained. All implant surgeries were completed
splinted implants may reveal a different incidence. In
by 1 periodontist (D.F.) in Calgary, Alberta, Canada, with
addition, authors are unaware of studies on the conse-
surgical principles and protocols as described in a pre-
quence of ICL and its potential effect on proximal bone,
viously published study.8 Restorations were completed
mucosal inflammation, or adjacent tooth caries.
by general dentists and prosthodontists in the Calgary
The purpose of this cross-sectional retrospective study
region, and restorations included implant-supported
was to report on the incidence of ICL from 4325 implant
single crowns and implant-supported fixed partial den-
sites, including proximal contact sites at single-implant
tures. There were 1448 implants where proximal splint-
restorations and splinted multiunit restorations. The inci-
ing was between implants, and in these situations, only
dence of ICL was evaluated in relation to time, location of
the contact points adjacent to a natural tooth were
the implant, and sex of the patient. Furthermore, the
evaluated.
impact of ICL on the implant crestal bone level (CBL), peri-
Measurements of ICL, implant mucosal index (IMI),
implant mucosal status, and adjacent tooth caries was
and CBL were made by the same examiner who placed
evaluated. The null hypothesis was that ICL is not a
the implants (D.F.), with no intraexaminer calibration
function of time and that no difference would be found
performed. To study the relationship of ICL over time,
between implants that have ICL and those that do not.
data from the most recent recall examination were re-
ported for each implant. For example, if an implant had a
MATERIAL AND METHODS
closed contact at the 1-year recall but subsequently
This retrospective cross-sectional study selected 4325 developed ICL at the 5-year recall, then the contact
implants where a potential proximal contact was present would be recorded as open in this analysis. Follow-up
between teeth and implants from an open cohort of 8942 visits after implant treatment were scheduled at 1-, 3-,
implants placed in private practice between March 1999 and 5-year intervals. After 5 years, the follow-up was less
and January 2016 (Fig. 1). The study was reviewed and structured, with participants returning either for routine
approved by the University of Alberta Institutional Re- follow-up visit or more extensive treatments (such as
view Board (HERO Pro00068903). Not all implants from more than 4 or 5 implants), when an additional implant
the open cohort had data for the ICL parameter, and surgery was indicated, or if a concern was noted by the
4617 implants were excluded because the implants had participant or by their referring dentist.
not yet been restored or were not yet due for scheduled ICL was evaluated using satin floss (width: 0.05 mm ×
recall after restoration; because the patient did not return height: 0.004 mm; Oral-B). If no resistance was noted
for any recall appointments or the most recent recall was with the floss as it passed the contact, then the proximal
before January 2005 (the date when ICL was first scored); contact was deemed an open contact (ICL).

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Total implants
placed (N=8942)

Splinted Implants with proximal

Diastema sites No contact data
implant-implant contact recorded
(n=4) (n=3165)
(n=1448) data (n=4325)

Implants placed Implants placed

in females (n=2433) in males (n=1892)

Implants placed Implants placed Implants placed Implants placed

in maxilla in mandible in maxilla in mandible
(n=1393) (n=1040) (n=1127) (n=765)

Implants in Implants placed Implants in Implants in

anterior region in anterior region anterior region anterior region
(n=578) (n=82) (n=524) (n=90)

Implants in Implants in Implants placed Implants in

posterior region posterior region in posterior region posterior region
(n=815) (n=958) (n=603) (n=675)

Figure 1. Flow chart of implant distribution.

Radiographs and clinical evaluation were performed

at stage 2 (3 months), 1 year, 2-3, 4-5, 6-7, and 8-10
years after implant placement. Radiographs were made
using a proprietary parallel film holder and software
calibrated to sensor dimensions (DEXIS). In each radio-
graphic image, the location of the implant-crown margin
(implant shoulder), the first crestal bone-to-implant
contact, and the apical border of the implant were
identified as reference points. For each implant, the
actual implant length served as the calibration value to
derive the distance from implant shoulder to the first
bone-to-implant contact. The CBL was then determined
from the distance from implant shoulder to the first
bone-to-implant contact minus the neck length of the
implant (Fig. 2). The following standardization values Figure 2. Reference used for crestal bone level analysis. CBL, crestal bone
were used to account for the different implant neck de- level; DIB, distance from implant shoulder to the first bone-to-implant
signs. For Straumann implants (Institut Straumann), contact; NL, neck length of machined or polished collar.
values were 2.8 mm for Standard tissue level, 1.8 mm for
Standard Plus tissue level and tapered effect, and 0 mm
for Bone Level implants. For the Biocare implants (Nobel distal measurement.9 During surgery, the border be-
Biocare), the value used was 1.5 mm for both the Biocare tween the smooth and the microrough surface was
Replace Select Ti-unite implants and for the machined positioned at the crestal level or slightly subcrestally, and
external hexagon implants. For each implant, CBL was CBL was thus an approximation for marginal bone loss
recorded as the greatest value from either the mesial or (MBL) that occurred after implant placement (Fig. 2).

French et al THE JOURNAL OF PROSTHETIC DENTISTRY

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Table 1. Summary of implant mucosal index (IMI) 100

IMI Bleeding on Probing*
Open
90 Closed
0 No bleeding
80
1 Minimal, single-point bleeding

Open or Closed (%)

2 Moderate, multipoint bleeding 70
3 Profuse, multipoint bleeding 60
4 Suppuration 50
*Probing 6 sites, probe 0.17 N.
40
30
Table 2. Number of implants and proximal contact status relative to 20
period of follow-up
10
Status Year 1 Years 2-3 Years 4-5 Years 6-7 Years 8+ Total
Open 150 (11%) 147 (14%) 127 (16%) 102 (23%) 200 (29%) 726 (17%)
0
1 2-3 4-5 6-7 8-10
Closed 1194 (89%) 879 (86%) 675 (84%) 341 (77%) 482 (71%) 3571 (83%)
After Placement (year)
Total 1344 (31%) 1026 (24%) 802 (19%) 443 (10%) 682 (16%) 4297
Figure 3. Interproximal contact loss relative to time of follow-up.

Peri-implant mucosal status was measured by using Table 3. Number of implants and proximal contact status as function of
maxillary versus mandibular sites
controlled force probe and evaluated by using the IMI, an
Maxilla Mandible Total
ordinal scale for evaluating soft tissue conditions incor-
Open 374 (15%) 355 (20%) 729 (17%)
porating graded bleeding on probing or suppuration
Closed 2146 (85%) 1450 (80%) 3596 (83%)
(Table 1).9 Teeth with caries adjacent to fixed implant
Total 2520 (58%) 1805 (42%) 4325
restorations were reported, and a comparison of the
caries rate when contact was open versus closed was
performed.
posterior sites (premolars and molars). ICL was signifi-
cantly more common on posterior implants, with 18% of
RESULTS
the posterior implants presenting with ICL versus 14% of
There were 4325 implants evaluated, with an average the anterior implants (chi-square: 13.8, P<.001).
follow-up duration of 4.47 years (range 0.25 to 21.6 A subanalysis was performed on 4200 implants with
years). Overall, most implants (83%) had closed contacts, recorded follow-up data as to whether the restorations
whereas 17% had ICL at the date of the last examination were in or out of occlusion. This was determined by using
(Table 2). ICL increased over time as seen by an ICL a 24-mm-thick occlusal film, with the patient exerting a
incidence of 11% by year 1, 14% by years 2-3, 16% by light occlusal force; if a single film was held, it was
years 4-5, 23% by years 6-7, and 29% by 8 years. The deemed to be in occlusion, whereas if it was pulled
chi-square statistic of 98.1 was significant (P<.001) through, it was deemed to be out of occlusion. Of the
(Table 2; Fig. 3). 4200 implants, 1897 restorations were in occlusion, and
ICL was more common mesial to an implant (N=484) of these, 358 (18.9%) had ICL, whereas 2303 restorations
than distal to an implant (N=66). A small number of were out of occlusion, with 354 (15.4%) having ICL (chi-
implants were found with both mesial and distal ICL, squares: 9.1, P=.003).
N=17. More implants were placed in the maxilla (58%) CBL results only included participants who had
than in the mandible (42%); however, a significantly completed 8 years of follow-up. A significant trend of
lower incidence of ICL was noted in maxillary sites, with increasing CBL scores was seen with increasing time of
15% of maxillary implants presenting with ICL compared follow-up (P<.001). Despite this overall increasing bone
with 20% of mandibular implants (Table 3; Fig. 4) (chi- loss as a function of time, no significant difference was
square: 17.5, P<.001). found for CBL comparing open proximal contacts (ICL)
There were 1404 (46%) premolar implants and 1647 or closed proximal contacts over time (Table 4; Fig. 5).
(54%) molar implants evaluated for ICL. Combining Data on peri-implant tissue tone using the IMI scores
molar and premolar sites, 556 (18%) implants presented of 0 to 4 were available and recorded for a subset of 4297
with ICL, of which 262 (19%) were at premolar implants implants with proximal contact data, of which a total of
and 294 (18%) were at molar implants. No statistical 3572 implants had closed contacts and 725 implants
difference for ICL was found between premolar and presented with ICL. The majority (60%) of implants had
molar sites (chi-square: 0.3, P=.56). IMI=0, whereas 28% had an IMI=1, 9% had an IMI=2,
Of the 4325 implants placed and evaluated for po- 2% had an IMI=3, and 1% had an IMI=4 (Table 5; Fig. 6).
tential ICL, 1274 implants were placed in anterior sites Of the closed contacts, 61% had an IMI=0, 27% had an
(incisors and canines), whereas 3051 were placed in IMI=1, 9% had an IMI=2, 2% had an IMI=3, and 1% had

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2500 0.45
Maxilla Open
0.4
Mandible Closed
2000 0.35

Bone Level (mm)

0.3
Implants (n)

1500 0.25
0.2
1000 0.15
0.1
500 0.05
0
0 1 2-3 4-5 6-7 8-10
Open Closed
Year
Proximal Contact
Figure 5. Effect of interproximal contact loss on crestal bone level (mm).
Figure 4. Interproximal contact loss relative to maxillary and mandibular
sites.
Table 5. Proximal contact status and corresponding implant mucosal
index
Table 4. Mean crestal bone level (mm) over time as function of proximal
Tissue Tone 0 1 2 3 4 Total
contact status
Open 383 (53%) 228 (31%) 81 (11%) 20 (3%) 13 (2%) 725
Descriptive Statistics
Closed 2176 (61%) 962 (27%) 318 (9%) 74 (2%) 42 (1%) 3572
Time Open or Closed Mean Standard Deviation N
Total 2559 (60%) 1190 (28%) 399 (9%) 94 (2%) 55 (1%) 4297
Year 1 Closed 0.28 0.52 372
Open 0.21 0.46 149
Total 0.26 0.51 521
Year 2-3 Closed 0.40 0.71 372 DISCUSSION
Open 0.28 0.51 149
Proximal contact opening adjacent to implant restora-
Total 0.37 0.66 521
Year 4-5+ Closed 0.40 0.65 372
tions is common, yet there remain few reports on the
Open 0.43 0.74 149
subject. Most studies report incidence or distribution in
Total 0.41 0.68 521 relatively small samples, and, to the authors’ knowledge,
Year 6-7 Closed 0.45 0.74 372 no study has evaluated the effect of time on ICL or the
Open 0.46 0.84 149 effect of ICL on hard or soft tissues. The present retro-
Total 0.45 0.77 521 spective study reported on the incidence of ICL from
Year 8-10 Closed 0.48 0.79 372 4325 implants as a function of time, implant location, and
Open 0.44 0.81 149 sex of the participant. It further evaluated the effects of
Total 0.47 0.80 521 ICL on surrounding hard and soft tissues. The null hy-
pothesis was rejected as significant differences in ICL
were found over time as well as significant differences in
an IMI=4. At the open contact sites, fewer implants had implants with and without ICL. Overall, this retrospec-
an IMI=0 (53%), 31% had an IMI=1, 11% had an IMI=2, tive study reported that 17% of the 4325 implants eval-
3% had an IMI=3, and a higher percentage at 2% had an uated presented with ICL; this is lower than a recent
IMI=4. A chi-square test based on the number of open review reporting between 34% and 66% of implants with
and closed contacts from each IMI score revealed a sig- ICL.3 The difference may be due in part to the inclusion
nificant trend toward greater mucosal inflammation at of single-tooth restorations and fixed partial dentures
implants with ICL, with a chi-square of 14.6 and P=.005 including implants in distal edentulous spans where no
(Table 5, Fig. 6). distal contact can be present, reducing the potential
Caries adjacent to fixed implant restorations were number of open contacts per implant. Furthermore, in
evaluated for 39 implants where both caries and prox- this study, the contact was deemed to be closed if any
imal data were recorded (Fig. 7). A total of 4286 im- resistance to flossing was found, which may differ from
plants placed with recorded interproximal data had no other studies. An important finding of this study was that
recorded adjacent dental caries. Of the 39 implants with the incidence of ICL increased with increasing time,
adjacent caries, 14 implants had ICL, whereas 25 im- and as such, the difference between various studies may
plants presented with closed interproximal contacts. also be due in part to the time of follow-up. Because the
This was compared with 715 open contacts with no average time of follow-up was only 4.47 years, a longer
adjacent caries versus 2571 closed contacts with no term average follow-up may yield a higher incidence of
adjacent caries. The chi-square statistic was 10.2 and ICL (Table 2; Fig. 3). Indeed, the incidence of ICL re-
P=.001. ported in this study was found to be lowest in the first

French et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume - Issue -

2500
Open
2000 Closed
Implants (n)

1500

1000

500

0
0 1 2 3 4 Figure 7. Example of dental caries adjacent to fixed implant restoration
Implant Mucosal Index and interproximal contact loss.
Figure 6. Effect of interproximal contact loss on implant mucosal index.

placement (Fig. 2). Although the implants in this study

year (ICL=11%) and nearly 3 times as common by 8 to 10 showed a trend toward more bone loss over time, no
years (ICL=27%), which approaches the reported average significant relationship was found between ICL and CBL
of other studies on single teeth.3 over time (Table 4, Fig. 5). This is an important finding
The finding that ICL was more prevalent with longer not previously reported in the literature as it may suggest
periods of follow-up suggests the mechanism is not an that open proximal contacts, although common, are not a
instant response of the adjacent tooth in contact with an significant risk factor for peri-implantitis. However, peri-
implant; this is in contrast to the suggestion that it occurs implant soft tissue IMI scores were higher at implants
within 3 months of restoration.3 ICL may instead be with ICL (P<.05), and higher IMI scores have been
related to longer term occlusal changes such as mesial shown in another study to correlate with bone loss over
drifting of the teeth and root angle, which supports time.9 The follow-up period of this present study was
similar results from other studies.4,5 This may also explain relatively short, and over longer follow-up, the presence
why most studies report a higher incidence in mesial of ICL may yet relate to more CBL around implants.
contact and why the present study found higher rates in The study by Varsith et al7 reported that patients were
mandibular sites (maxilla ICL=15% and mandible aware of food impaction, which may predispose adjacent
ICL=20%) as lower teeth are typically tipped mesially teeth to caries.11 In this present study, dental caries
(Table 3; Fig. 4).5 adjacent to a fixed implant restoration rate doubled when
Molar and premolar implants had a similar incidence contact was open versus closed at 2% and 1%, respec-
of ICL at 18% and 19%, respectively, whereas anterior tively (Fig. 7). Thus, when ICL is noted, the use of an
implants had a lower incidence at 14%. The authors are interdental proxybrush with fluoride gel may be advis-
unaware of a previous study that evaluated the effect of able. Indeed, this may be safer than flossing, which can
the position in the arch on the incidence of ICL. leave shredded fragments trapped on microrough sur-
The present study also found only slightly higher ICL faces and thus increase the risk of peri-implantitis.12
rates in men than in women, but the difference was not The results of this present study on the incidence of
significant. Men typically have a higher occlusal force, ICL at implant restorations support other studies stating
and the occlusal force is typically higher in molars than that patients need to be informed of the common po-
premolars.10 The lack of significant difference as a func- tential for ICL.7 More importantly, as the problem in-
tion of sex of the participant suggests that occlusal force creases with time, management of implant ICL will
may not be so critical to the development of ICL, which is increasingly be an issue that warrants further innovation,
in contrast with the finding of a prior study that high research, and discussion.
occlusal forces were a factor in ICL.5 Also important was One limitation identified in this retrospective study
the observation of a slight trend toward higher incidence was the potential for missing data. Not all implants had
of ICL when the restorations were in occlusion ICL recorded because, before 2005, this parameter was
(ICL=18.9%) versus out of occlusion (ICL=15.4%). not assessed unless these patients were recalled after
Where a restoration is kept out of occlusion, the adjacent 2005. Another limitation was that all the sites were
tooth may sustain more occlusal force, and because these evaluated and recorded by the same clinician who placed
did not present with a higher incidence of ICL, this also the implants, thus introducing a risk of bias. In addition,
suggests that occlusal force is not so critical in the dropouts, common to long-term clinical studies, were not
development of ICL. fully accounted for due to practical limitations in an
During surgery, the border between the smooth and open-cohort private practice study. Notwithstanding, this
the microrough surface was positioned at the crestal level study represents a unique private practice report on a
or slightly subcrestally. CBL, in this study, was thus an large number of implants and their relation to the inci-
approximation for the MBL that occurred after implant dence of ICL. This study found that open contacts

THE JOURNAL OF PROSTHETIC DENTISTRY French et al

- 2019 7

increase with time, suggesting that the longer the clini- 5. Wei H, Tomotake Y, Nagao K, Ichikawa T. Implant prostheses and adjacent
tooth migration: preliminary retrospective survey using 3-dimensional
cian restores dental implants, the more the resources will occlusal analysis. Int J Prosthodont 2008;21:302-4.
eventually be required to address the open contacts. An 6. Gibbard LL, Zarb G. A 5-year prospective study of implant-supported single-
tooth replacements. J Can Dent Assoc 2002;68:110-6.
effort toward the prevention of ICL through the use of a 7. Varthis S, Randi A, Tarnow DP. Prevalence of interproximal open contacts
retainer and other treatment options warrants further between single-implant restorations and adjacent teeth. Int J Oral Maxillofac
Implants 2016;31:1089-92.
investigation. 8. French D, Larjava H, Ofec R. Retrospective cohort study of 4591
Straumann implants in private practice setting, with up to 10-year
follow-up. Part 1: multivariate survival analysis. Clin Oral Implants Res
CONCLUSIONS 2015;26:1345-54.
9. French D, Cochran D, Ofec R. Retrospective cohort study of 4591 Straumann
Based on the findings of this clinical study, the following implants placed in 2060 patients in private practice with up to 10-year follow-
conclusions were drawn: up: The relationship between crestal bone level and soft tissue condition. Int J
Oral Maxillofac Implants 2016;31:e168-78.
10. Ferrario VF, Sforza C, Serrao G, Dellavia C, Tartaglia GM. Single tooth bite
1. From a large number of proximal contacts between forces in healthy young adults. J Oral Rehabil 2004;31:18-22.
implants and teeth followed up for an average of 11. Hayes M, Da Mata C, Cole M, McKenna G, Burke F, Allen PF. Risk indicators
associated with root caries in independently living older adults. J Dent
4.47 years, 17% of sites had ICL, and the incidence 2016;51:8-14.
increased over time with up to 29% implants having 12. Van Velzen FJJ, Lang NP, Schulten EAJM, ten Bruggenkate CM. Dental floss
as a possible risk for the development of peri-implant disease: An observa-
ICL by 8 or more years of follow-up. tional study of 10 cases. Clin Oral Implants Res 2016;27:618-21.
2. No effect of ICL was found on MBL noted, but there
was a trend toward higher mucositis in areas of ICL.
Corresponding author:
Dr David French
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French et al THE JOURNAL OF PROSTHETIC DENTISTRY