This has been explained by Frost. He has identified osteocytes as an important part of the cellular machinery of bone functional adaptation. When the strain stimulus surpasses the homeostatic regulatory mechanism threshold, but is below the bone fatigue failure, tissue level strains lead to fluid flow-mediated osteocyte and dendrite perturbation and release of anabolic factors. In turn, osteoblasts are recruited and the bone is subsequently formed primarily on trabecular and periosteal surfaces—effectively increasing whole bone strength.

Crown to implant ratio

An example of this phenomenon is demonstrated with implants that have a crown to implant ratios of greater than 1 to 1. A number of investigators reported counterintuitive results when high clinical crown to implant ratios (2–3 C/I ratio) did not have the expected catabolic result, but instead caused an anabolic change in the bone. The use of short implants when there is a significant interocclusal distance has similarly been successful, even when compared to longer implants with bone augmentation. It also offers a methodological pathway to look at relative force/field units in the anabolic/catabolic bone continuum and its tipping point for peri-implantitis.

Implant cantilever prostheses

Another implant prosthetic design that has been assumed to cause occlusal overload is the cantilever prosthesis. However, systematic reviews and meta-analyses as well as long-term follow-up studies of cantilevers in the partially edentulous patients have demonstrated similar marginal bone levels as the fixed dental prostheses without a cantilever. This is irrespective of the use of a mesial or distal cantilever. However, there are limits dictated by the design of the cantilever.

Non-axial forces on natural teeth are mediated through the tensile loading of the principal fibers of the periodontal ligament (PDL), and the occlusal load is transmitted to the surrounding bone.