Crestal bone loss due to abutment manipulation and an internal silver deposition implant design in a canine model



The study aimed to evaluate the effect of internal silver coating as a countermeasure to crestal bone loss around implants with or without multiple abutment disconnections/reconnections.

Materials and methods

Following tooth extraction, 48 implants with connected healing abutments (24 implants internally coated with elemental silver) were placed in the mandible of eight beagle dogs. Two months after implant surgery one side of the mandible was randomly assigned to four abutment manipulations (disconnection/reconnection) on a weekly basis. At 4 months postoperative, biopsies were obtained and prepared for histomorphometric analysis.


Healing abutment manipulation increased crestal bone remodeling when compared to no abutment manipulation (1.28 mm versus 0.92 mm, respectively), although the difference was not statistically significant (p = 0.0836). Overall, an internal silver coating did not provide a statistically sufficient implant treatment characteristic as a countermeasure to crestal bone loss (p = 0.7801).


These findings indicate that the controlled variables explored here (abutment manipulation/internal silver coating) have a limited effect on initial crestal bone loss.

Clinical relevance

Abutment manipulation during prosthetic work does not seem to harm the peri-implant soft and hard tissues.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9


  1. 1.

    Albrektsson T, Zarb G, Worthington P, Eriksson A (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria for success. Int J Oral Maxillofac Surg 1:11–25

    Google Scholar 

  2. 2.

    Smith DE, Zarb GA (1989) Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 62:567–572

    Article  Google Scholar 

  3. 3.

    Hermann J, Buser D, Schenk RK, Schoolfield J, Cochran DL (2001) Biologic width around one- and two-piece titanium implants: a histometric evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. Clin Oral Implants Res 12:559–571

    Article  Google Scholar 

  4. 4.

    Hermann J, Cochran DL, Nummikoski P, Buser D (1997) Crestal bone changes around titanium implants: a radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol 68:1117–1130

    Article  Google Scholar 

  5. 5.

    Tarnow DP, Cho SC, Wallace SS (2000) The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 71:546–549

    Article  Google Scholar 

  6. 6.

    Broggini N, McManus LM, Hermann JS, Medina R, Schenk RK, Buser D, Cochran DL (2006) Peri-implant inflammation defined by the implant-abutment interface. J Dental Res 85:473–478

    Article  Google Scholar 

  7. 7.

    Ericsson I, Persson LG, Berglundh T, Marinello CP, Lindhe J, Klinge B (1995) Different types of inflammatory reactions in peri-implant soft tissues. J Clin Periodontol 22:255–261

    Article  Google Scholar 

  8. 8.

    Abrahamsson I, Berglundh T, Lindhe J (1997) The mucosal barrier following abutment disconnection: an experimental study in dogs. J Clin Periodontol 24:568–572

    Article  Google Scholar 

  9. 9.

    Lazzara RJ, Porter SS (2006) Platform switching: a new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 26:9–17

    PubMed  Google Scholar 

  10. 10.

    Koutouzis T, Gadalla H, Lundgren T (2016) Bacterial colonization of the implant-abutment interface (IAI) of dental implants with a sloped marginal design: an in-vitro study. Clin Implant Dent Relat Res 18(1):161–167

    Article  Google Scholar 

  11. 11.

    Zhao L, Chu P, Zhang Y, Wu Z (2009) Antibacterial coatings on titanium implants. J Biomed Mater Res B Appl Biomater 91B:470–480

    Article  Google Scholar 

  12. 12.

    Podhorsky A, Biscoping S, Rehmann P, Streckbein P, Domann E, Wöstmann B (2016) Transfer of bacteria into the internal cavity of dental implants after application of disinfectant or sealant agents in vitro. Int J Oral Maxillofac Implants 31(3):563–570

    Article  Google Scholar 

  13. 13.

    Berger T, Spadaro J, Chapin S, Becker R (1976) Electrically generated silver ions: quantitative effects on bacterial and mammalian cells. Antimicrob Agents Chemother 9:357–358

    Article  Google Scholar 

  14. 14.

    Li J, Wang J, Shen L, Xu Z, Li P, Wan G, Huang N (2007) The influence of polyethylene terephthalate surfaces modified by silver ion implantation on bacterial adhesion behavior. Surf Coat Technol 201:8155–8159

    Article  Google Scholar 

  15. 15.

    Wan Y, Raman S, He F, Huang Y (2007) Surface modification of medical metals by ion implantation of silver and copper. Vacuum 81:1114–1118

    Article  Google Scholar 

  16. 16.

    Chen W, Liu Y, Courtney H, Bettenga M, Agrawal C, Bumgardner J, Ong J (2006) In vitro anti-bacterial and biological properties of magnetron co-sputtred silver-containing hydroxapatite coating. Biomater 27:5512–5517

    Article  Google Scholar 

  17. 17.

    Ewald A, Gluckermann S, Thull R, Gbureck U (2006) Antimicrobial titanium/silver PVD coatings on titanium. Biomed Eng Online 5:22

    Article  Google Scholar 

  18. 18.

    Donath K (1993) Preparation of histological sections (by the cutting-grinding technique for hard tissue and other material not suitable for sectioned by routine methods)—equipment and methodological performance. Exakt, Kulzer Publication, Norderstedt

    Google Scholar 

  19. 19.

    Mendenhall W, Beaver RJ (1994) Introduction to probability and statistics, 9th edn. Duxbury Press, N. Scituate

    Google Scholar 

  20. 20.

    Kohles SS, Kohles DA, Karp AP, Erlich VM, Polissar NL (2004) Time-dependent surgical outcomes following cauda equina syndrome diagnosis: comments on a meta-analysis. Spine (Phila Pa 1976) 29(11):1281–1287

    Article  Google Scholar 

  21. 21.

    Freeman MD, Kohles SS (2012) Assessing specific causation of mesothelioma following exposure to Chrysotile Asbestos-containing brake dust. Int J Occup Environ Health 18(3):329–336

    Article  Google Scholar 

  22. 22.

    Hoenig JM, Heisey DM (2001) The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat 55(1):1–6

    Article  Google Scholar 

  23. 23.

    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  24. 24.

    Stern JAC, Smith GD (2001) Sifting the evidence—what's wrong with significance tests? BMJ 322:226–231

    Article  Google Scholar 

  25. 25.

    Adell R, Lekholm U, Rockler B, Branemark PI, Lindhe J, Eriksson B, Sbordone L (1986) Marginal tissue reactions at osseointegrated titanium fixtures (I). A 3-year longitudinal prospective study. Int J Oral Maxillofac Surg 15:39–52

    Article  Google Scholar 

  26. 26.

    Adell R, Lekholm U, Rockler B, Branemark PI (1981) A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10:387–416

    Article  Google Scholar 

  27. 27.

    Cox J, Zarb G (1987) The longitudinal clinical efficacy of osseointegrated dental implants: a 3-year report. Int J Oral Maxillofac Surg 2:91–100

    Google Scholar 

  28. 28.

    Jemt T, Lekholm U, Gröndahl K (1990) A 3-year follow up study of early single implant restoration ad modum Branemark. Int J Periodontics Restor Dent 10:341–349

    Google Scholar 

  29. 29.

    Schwarz F, Hegewald A, Becker J (2014) Impact of implant-abutment connection and positioning of the machined collar/microgap on crestal bone level changes: a systematic review. Clin Oral Implants Res 25(4):417–425

    Article  Google Scholar 

  30. 30.

    Quirynen M, van Steenberghe D (1993) Bacterial colonization of the internal part of two-stage implants: an in vivo study. Clin Oral Implants Res 4:158–161

    Article  Google Scholar 

  31. 31.

    Oh T, Yoon J, Misch C, Wang H (2002) The causes of early implant bone loss: myth or science? J Periodontol 73:322–333

    Article  Google Scholar 

  32. 32.

    von Recum A (1986) Handbook of biomaterial evaluation. Macmillan Publishing Co., New York

    Google Scholar 

  33. 33.

    Misch C (1999) Dental evaluation: factors of stress, 2nd edn. Mosby, St. Louis

    Google Scholar 

  34. 34.

    Koutouzis T (2019) Implant-abutment connection as contributing factor to peri-implant diseases. Periodontol 81(1):152–166

    Article  Google Scholar 

  35. 35.

    Degidi M, Nardi D, Piattelli A (2011) One abutment at one time: non-removal of an immediate abutment and its effect on bone healing around subcrestal tapered implants. Clin Oral Implants Res 22(11):1303–1307

    Article  Google Scholar 

  36. 36.

    Grandi T, Guazzi P, Samarani R, Garuti G (2012) Immediate positioning of definitive abutments versus repeated abutment replacements in immediately loaded implants: effects on bone healing at the 1-year follow-up of a multicentre randomised controlled trial. Eur J Oral Implantol 5(1):9–16

    PubMed  Google Scholar 

  37. 37.

    Hartlev J, Kohberg P, Ahlmann S, Gotfredsen E, Andersen NT, Isidor F, Schou S (2013) Immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment: a clinical and radiographic retrospective study. Clin Oral Implants Res 24(6):652–658

    Article  Google Scholar 

  38. 38.

    Abrahamsson I, Berglundh T, Sekino S, Lindhe J (2003) Tissue reactions to abutment shift: an experimental study in dogs. Clin Implant Dent Relat Res 5:82–88

    Article  Google Scholar 

Download references


The authors acknowledge collegial collaborations with Drs. James N. Kenealy, Arndt Happe, and Markus B. Hürzeler, as well as the histological contributions of Michael Rohrer and Hari Prassad.


Partial support for this study was provided by Biomet 3i (now Zimmer Biomet Dental). Author SSK also acknowledges support from the National Institutes of Health (P20 MD003350).

Author information



Corresponding author

Correspondence to Sean S. Kohles.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research described herein complied with all international guidelines for the ethical treatment of animals.

Informed consent

Formal consent was not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fickl, S., Stappert, C.F.J. & Kohles, S.S. Crestal bone loss due to abutment manipulation and an internal silver deposition implant design in a canine model. Clin Oral Invest 25, 515–523 (2021).

Download citation


  • Crestal bone regression
  • Internal silver coating
  • Abutment manipulation
  • Animal model
  • Histomorphometrics
  • Edentulous remodeling
  • Design countermeasure