Prevention of initial bone remodelling around dental implants: an international clinical consensus utilising the Delphi method

Purpose: To establish an expert consensus on the definition, diagnostic boundaries and clinical interpretation of initial bone remodelling around dental implants and identify evidence-based strategies for its prevention and management. materials and methods: A three-round Delphi consensus process was conducted using an established methodology. Twenty-five internationally recognised experts in implant dentistry, identified through a structured literature search, participated anonymously. Fifteen statements were developed by a coordinating group to address the definition, clinical implications and aetiopathogenesis of initial bone remodelling. Agreement was rated on a 9-point Likert scale, with consensus defined as a mean score ≥ 7 and ≤ 1 outlier. Results: All 25 experts completed each round. Of the 15 statements evaluated, 10 reached full consensus, one achieved near consensus and four did not reach the predefined threshold. No consensus was achieved regarding the definition, temporal reference or prognostic significance of initial bone remodelling, highlighting the persistent heterogeneity in terminology and diagnostic interpretation. In contrast, strong agreement was achieved on the biological and mechanical determinants of initial bone remodelling, including implant–abutment configuration, platform switching, peri-implant bone volume, insertion torque, soft tissue thickness and phenotype, abutment height, prosthetic emergence profile and the presence of undetected residual cement. Conclusions: Initial bone remodelling remains variably defined but is increasingly recognised as a controllable rather than an inevitable process. A shared conceptual and diagnostic framework is needed to standardise clinical interpretation, guide preventive strategies and support more rigorous future research on peri-implant bone stability.