## 4 Discussion  
This study evaluated the influence of certain patient-dependent and surgical-dependent factors on early MBL. The overall mean of MBL was 0.45 \(\pm\) 0.48 mm at an average follow-up of six months after implant installation, confirming the first study hypothesis that early MBL occurs, even before prosthetic loading. These results were lower than the two-month follow-up mentioned by [PERSON] et al. (2016), for which the authors reported a mean MBL of 0.86 mm. The MBL at implant sites with low and high torque was greater than MBL related to regular toque. Considering the dichotomous analysis, only high torque negatively influenced MBL (\(p\) = 0.033), confirming the second hypothesis of the study. [PERSON] et al. (2017) suggested that MBL is statistically lower in implants installed with regular torque than with high torque 12 months after surgery. They reported 1.01 \(\pm\) 0.57 mm of MBL with high torque and 0.68 \(\pm\) 0.46 mm of MBL with regular torque, both in the maxilla. In the mandible, they observed 1.33 \(\pm\) 0.33 mm for high torque and 0.70 \(\pm\) 0.28 mm for regular torque. The authors considered high torque to be greater than 50 Ncm and regular torque lower to be than this value. In contrast, [PERSON] et al. (2018) evaluated the MBL of implants with regular torque (30 to 45 Ncm) and high torque (up to 80 Ncm) after 12 months of installation, and observed no significant differences between the groups. To correctly mill the surgical site the bone type and implant macro and micro geometry should be considered. This presents a challenge, although this association does seem to be important in avoiding high torques. In the multilevel linear regression model, the time for reopening was relevant: a period longer than six months increased the MBL by 0.46 mm. However, this difference was not observed in the dichotomous evaluation. The literature is scarce regarding the time between installation surgery and reopening. The manufacturers recommend at least three months for complete healing, but some studies report the success of implants with early and immediate loading ([PERSON] et al., 2016; [PERSON] et al., 2017). According [PERSON] et al. (2017) conventional loading of dental implants is considered to be more than two months after the implant installation; early loading occurs between one week and two months; and immediate loading occurs within one week of implant installation. In the present study, the period before reopening varied, since some patients received bone grafts. Additionally, the implants were installed in university centers, where the vacation period can extend the time between implant installations and loading; many patients were from other cities, which also made callbacks difficult. Clinically, the time to reopening may vary, and this study aimed to demonstrate a realistic situation, which was found to be between three and nine months. The process of healing and osseointegration in dental implants is a dynamic process. When an implant is installed, surgical preparation results in physiological MBL (Kal  
no significant difference in the MBL of diabetic and non-diabetic subjects at six years of follow-up was detected; in this study, all diabetic individuals presented glycemic levels within the normal range (mean glycated hemoglobin levels of 4.86%). Fasting glucose was used as a reference, as it is accepted by the American Diabetes Association [26]. The glycemic levels of the group of diabetic patients ranged between 68.1 and 104 mg/dL, demonstrating that they were controlled. In the analysis with the continuous variable, younger patients showed higher MBL compared with older individuals (\(p\) = 0.047). The mean age of the patients included in the study was 54.1 years old. Most of the studies did not reveal a relationship between implant failure and MBL with patient age [27; 28]. [PERSON] et al. [29] reported that the bone density at implant sites is lower in older patients (\(>\)50 years) than in younger patients (\(\leq\)50 years).