## 4 Discussion
In contrast, the full-thickness periosteal flap elevation technique used by [PERSON] et al. [38] provides excellent access and visibility but may lead to greater disruption of the periosteal blood supply, which is essential for bone healing and regeneration. The use of regular-diameter implants (RDIs) showed a 100% success rate, while narrow-diameter implants (NDIs) showed 95% success rate in the posterior jaws, as investigated by [PERSON] et al. [42]; this addresses the challenge of limited bone availability while still maintaining adequate support for occlusal forces. Studies with extended follow-ups, such as the 12-year retrospective analysis by [PERSON] et al. [44], offer valuable insights into the behavior of soft tissue contours and marginal bone over time. In contrast, shorter follow-up periods, like the one-year assessment reported by [PERSON] et al. [49], may not capture the full spectrum of bone remodeling that occurs post-implantation. Despite the use of similar surface treatments, the study by [PERSON] et al. [39] reported a mean peri-implant bone loss of 0.12 \(\pm\) 1.47 mm for bone-level implants and 0.04 \(\pm\) 1.3 mm for soft tissue-level implants, whereas [PERSON] et al. [40] observed a mean bone loss of \(-\)0.58 \(\pm\) 0.39 mm for NDIs and \(-\)0.53 \(\pm\) 0.46 mm for RDIs over a three-year period. These discrepancies highlight the multifactorial nature of bone loss, influenced by not only the implant's physical characteristics but also by the surgical technique and patient factors. As we can see, the relationship between implant characteristics and MBL is multifaceted and influenced by a variety of factors. The collective evidence from the studies [38; 39; 40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50; 51; 52; 53; 54] underscores the need for careful consideration of implant design, surface treatment, and placement techniques in the pursuit of optimizing clinical outcomes. It also points to the necessity of individualizing implant selection based on patient-specific anatomical and functional requirements to maximize the potential for implant success and longevity. The standardization of measuring MBL is critical to compare results across studies. While most studies utilize radiographic assessments, the precision and angles of radiographs can vary, potentially affecting the measurement of bone levels [38; 39; 41]. Moreover, the timing of these measurements can influence the perceived rate of bone loss. For instance, studies with longer follow-up periods, such as that by [PERSON] et al. [43], which considered a 10-year timeframe, offer insights into the long-term stability of peri-implant bone. In contrast, shorter-term studies may not capture the complete trajectory of bone remodeling [45]. When comparing quantitative results, the studies present a range of MBL figures, from the minimal loss reported by [PERSON] et al. [39] to the more significant loss in the study by [PERSON] et al. [40]. These discrepancies can be attributed to differences in implant design, surgical techniques, and patient management. For example, the implementation of platform switching, as reported by [PERSON] et al. [48], is known to influence peri-implant bone levels favorably. Such design modifications can mitigate stress concentration at the bone-implant interface and slow the progression of bone loss. [PERSON] et al. [48] reported a mean preimplant bone loss of 0.04 mm in infra-crestal implants, 0.26 mm in crestal implants, and 0.19 mm in supra-crestal implants, while [PERSON] et al. [49] reported lower MBL in the sub-crestal group than in the crestal group (0.04 \(\pm\) 0.08 vs. 0.17 \(\pm\) 0.17 mm, \(p\) = 0.004). Covariates play a pivotal role in the interpretation of data and the understanding of bone loss around dental implants. Patient-related factors such as age, hygiene practices, and systemic health conditions can significantly influence the healing and maintenance of peri-implant tissues [43].