{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:28:20Z","timestamp":1787160500155,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sociedad Espa\u00f1ola de Pr\u00f3tesis Estomatol\u00f3gica"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>A clinically unresolved question in full-arch implant rehabilitation is whether early peri-implant bone adaptation is primarily a local (implant-level) phenomenon, a shared within-arch response, or a patient-level characteristic\u2014information is unavailable from conventional mean-based outcome reporting. This prospective secondary analysis quantified the hierarchical distribution of peri-implant marginal bone level change (\u0394MBL) in monolithic zirconia full-arch prostheses directly connected to multi-unit abutments during the first year of function. Unlike mean-based endpoints, this approach identifies whether early bone adaptation variability originates primarily at the implant, prosthetic-arch, or patient level. Of 308 implants placed in 40 completely edentulous patients rehabilitated with 49 prostheses, 2 implants failed before delivery of the definitive prosthesis and were excluded from radiographic analysis, leaving 306 implants available for multilevel analysis. Implant-level \u0394MBL was analyzed using an unconditional three-level linear mixed-effects model. Implant survival was 99.2%, prosthetic survival was 100%, and mean \u0394MBL at 12 months was 0.38 \u00b1 0.27 mm. Variance partitioning showed that 60.8% of total variability occurred at the implant level, 28.4% occurred at the patient level, and 10.8% occurred at the prosthetic-arch level, providing a framework for identifying at which level of the restorative system future clinical interventions may have the greatest impact. Findings should be interpreted within the context of a secondary analysis with a 12-month follow-up and no explanatory covariates; longer-term comparative studies with explanatory multilevel designs are required to confirm and extend these observations.<\/jats:p>","DOI":"10.3390\/bioengineering13060632","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:57:43Z","timestamp":1779962263000},"page":"632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hierarchical Variance in Early Marginal Bone Change in Monolithic Zirconia Full-Arch Implant Prostheses: A Multilevel Prospective Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9962-0338","authenticated-orcid":false,"given":"Luis Carlos","family":"Garza","sequence":"first","affiliation":[{"name":"Department of Restorative Dentistry, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Crooke","sequence":"additional","affiliation":[{"name":"Private Practice, 29016 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-8788","authenticated-orcid":false,"given":"Marta","family":"Vall\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Soliva","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8978-8230","authenticated-orcid":false,"given":"Xavier","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4872-4118","authenticated-orcid":false,"given":"Miguel","family":"Roig","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","first-page":"13","article-title":"Full-arch implant-supported monolithic zirconia fixed dental prostheses: An updated systematic review","volume":"14","author":"Thalji","year":"2021","journal-title":"Int. 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Oral Implants Res."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/6\/632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:36:53Z","timestamp":1779964613000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/6\/632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["bioengineering13060632"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13060632","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}