Open contacts adjacent to posterior dental implants: Current understanding and emerging preventive concepts

Open proximal contacts between posterior dental implant restorations and adjacent natural teeth are a common yet underappreciated complication. This review examines the multifactorial etiology of open contact formation, including biomechanical discrepancies, prosthetic and surgical factors, occlusal force dynamics, and natural tooth migration. The clinical consequences-ranging from food impaction and gingival inflammation to proximal bone loss and diminished patient satisfaction-are also analyzed. These complications not only affected oral hygiene and comfort but might also contribute to peri-implant tissue breakdown and increased maintenance needs. Existing preventive and corrective strategies, such as prosthetic over-contouring, splinted restorations, and occlusal equilibration, are reviewed with attention to their limitations in long-term effectiveness. In response, this article introduces biomechanically informed occlusal adjustment concepts, including the mesial-mesial/distal-distal (MM-DD) technique, as a potential proactive approach. While preliminary clinical observations suggest that the MM-DD technique may help preserve proximal contact integrity and reduce implant-related complications, further prospective validation is required. This review provides a balanced synthesis of current evidence and evolving strategies to enhance the long-term stability of proximal contacts in posterior implant therapy.