This is a unique finding in the literature and may reflect altered remodeling potential of bone, or it may also be the effect of a few outlier cases where sudden MBL was noted in some but not all bisphosphonate cases. Conclusions drawn are limited however as the duration or dose of bisphosphonate therapy was not recorded in this study.

Interestingly, diabetes (pooled type 1 and type 2) was not found to have a significant effect on MBL. However, the majority were type 2 and the average follow‐up was <4 years, therefore some diabetic cases may yet succumb to further MBL. More patients and a longer follow‐up time are needed to better assess this result. Similarly, a history of periodontal disease (pooled chronic and aggressive) was not found to have a significant effect on MBL in this study. However, the protocol for implant placement in periodontally involved patients was that the site of extraction had healed completely and thorough pre‐surgical root planing and regular recall was established. Conclusions are limited by an average of 4 years follow‐up, which may not be enough to reflect the risk and that oral hygiene was not directly evaluated as a risk indicator, it was only observed indirectly via the soft‐tissue IMI score.

As for implant factors, including location, diameter and design, all were found to be significant with regard to marginal MBL. A difference in CBL at the start was observed in various locations with the most MBL found early on at the maxillary anterior sites. This may relate to the thin crestal bone remodeling at these sites or also to the use of bone graft for esthetic augmentation.