Normal Pattern of Bone Loss

I get situations like this referred to me quite often where the referring dentist diagnosis “Bone Loss around Implant”. I will let each person reach their own conclusion but I would consider this normal for the type/design of implant that was used… I did not place this fixture but it appears to be a Bio Horizon (terrible product in my opinion) with a traditional flat top internal hex connection. Prior to platform switching/medialized abutments/conical connections it was considered normal to see bone loss down to the first thread. While we could criticize the placement and or diameter of this fixture I do not believe it has pathological bone loss but rather a normal pattern for the device that was used…

I guess one of hint that this is Normal, physiological bone loss, or as some others might contend, “formation of biological width around an implant.”, is the fact that the bone loss should be monitored overtime after loading for 1+ year, to see if bone loss is actually increasing before deeming it “Bone Loss”. Cortical bone is evident around the implant from that PA.
Also, I have had some resolution of bone loss or actual “growth” (Dare I say that word) by just adjusting patient’s occlusion at times, so need to diagnose the issue before sending the patient to you.

My $0.02