Zero bone loss concepts

Dr. Tomas Linkevicius
Madrid, January 13, 2023
· 08/02/2022



It seems like crestal bone loss was with us forever, and that really for majority of clinicians became a norm. Maybe that’s because we all have been taught by Albrektsson et al from 1986, that 1.5 mm of bone loss within the first year of loading can be considered as a success, if later bone loss does not exceed 0.2 mm annually. There are so many possible reasons for bone loss, that dentists think that is not possible to control all of them and tend to give up the idea of crestal bone stability. However, I consider it outdated and not accepting the idea that bone loss in unavoidable. That was why with my research team we have developed Zero bone loss concepts – clear clinical protocols meant to develop and maintain crestal bone stability around implants.

To begin with surgery, several factors must be considered – sufficient vertical soft tissue thickness, polished neck and microgap, which dictate implant placement depth. It has been shown that at least 3 mm of vertical soft tissue thickness is required, and if implant is placed according to its design in appropriate position, surgical bone stability will be achieved. Prosthetic factors include screw-retained restorations, titanium bases with high gingival parameter, and polished zirconia in subgingival space to develop epithelial adherence.

In conclusion, no one factor is the most important to ensure crestal bone stability. It is the combination and interaction of factors that determine the outcome. It is only through accepting this multifactorial reality that clinicians can change their thinking and begin on the path to zero bone loss.

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Development of crestal bone stability. Surgical part

Influence of vertical soft tissues on crestal bone stability. Does platform switch save the bone? Influence of implant placement depth on crestal bone stability. What is the importance of implant-abutment connection stability? Bone remineralization and corticalisation processes in thick tissues. What is the role of bone in “Zero bone loss concepts”?

Four novel methods to increase vertical soft tissue thickness

  1. Subcrestal implant placement
  2. Flattening of the alveolar bone
  3. “Tent pole” technique
  4. Vertical soft tissue thickening

Maintenance of crestal bone stability. Prosthetic part

How to control cement remnants after cementation. Supragingival margins and individual abutments. Use of rubber-dam for cement prevention. Relation between cement and peri-implant disease. Screw-retained restorations. Use of Ti-base for fabrication of restorations.

Subgingival prosthetic materials. Zirconia, titanium, ceramics – which is better. Use of ultra-polished zirconia for implant restorations. Composition of peri-implant soft tissues. Supragingival materials. Ceramics, e.max, monolithic Zr – where to use and why?


  • LANGUAGE: English (Simultaneous spanish translation available)
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