Maturation and adaptation: (18 to 54 weeks)

The final stage involves maturation and adaptation of the implant-bone interface, peri-implant bone and the entire implant supporting skeletal element. This process continues for years or during entire lifetime of implant. Remodeling is influenced by mechanical, metabolic and age related factors. The excess endosteal and periosteal callus is resorbed and stronger bone structures develop in regions under higher strain. If remodeling is not stimulated by loading, or if the rate of bone formation decreases with age, a negative turnover in bone mass just as in osteoporosis is the\ result.

After excessive interfacial remodeling (due to increased resorption or reduced formation of new bone), the bone-implant contacts can not withstand overloading, and direct bone-implant apposition is prevented by relative motion of the implant. As in inadequate primary implant stabilization during initial healing phase or during premature overloading, a layer of fibrous connective tissue develops around the implant. This resultant peri-implant radiolucency indicates the first sign of implant loosening