Risk factors contributing to interproximal contact loss between an implant crown and a natural tooth

Purpose: Interproximal contact loss (ICL) is considered a prevalent complication for a tooth abutting an implant restoration. While numerous potential causes for ICL have been presented, there is no consensus. A review of the current literature with a focus on possible risk factors was performed.

Materials and methods: A PubMed search using keywords "implant OR dental implants OR implant supported prosthesis AND proximal contact loss OR ICL OR loss of interproximal contact OR open contact OR interproximal open contact OR adjacent natural teeth" resulted in 81 citations, 9 of which were relevant to the focus question. Additional references were culled from the reference lists in the identified articles. Systematic reviews, case series, and case reports were reviewed with a focus on causation, association, or correlation.

Results: Eight systematic reviews and 14 case series were reviewed. The prevalence of ICL has been reported to be as low as 16% and as high as 66%. ICL was more common on the mesial side of implants and when a tooth abuts a splinted implant restoration. The absence of a uniform definition to accurately describe an interproximal (IP) contact and an open IP contact is demonstrated in the literature. A lack of standardized measurement strategies that relate to a needed consensus definition further exacerbates the broad range of reported results regarding ICL. The lack of controls for almost all the ICL literature makes it difficult to draw conclusions and comparisons to unrestored, natural tooth IP contacts and the prevalence of ICL in this patient population. As a result, the available studies are inadequate to support a causal theory and the potential risk factors associated with ICL.

Conclusions: There is a large range of reported prevalence for IP contact loss. ICL is more common when a natural tooth abuts a splinted implant restoration. ICL is more common on the mesial, as opposed to the distal, of an implant retained restoration. Consensus in the definition and measurement strategies for ICL needs to be established to provide standardized terminology and methodology. Potential risk factors such as occlusion, restorative material, and tooth contact area need to be investigated.