Peri‐implantitis

Abstract

1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

The peri‐implant phenotype

“…According to the consensus of Group 4 at the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions, the evidence is equivocal regarding the effect that the presence or absence of keratinized mucosa has on the long‐term health of the peri‐implant tissues 3 . According to Schwarz et al., although some studies suggest that the absence of or an inadequate amount of KMW may negatively affect self‐performed oral hygiene measures, 4–6 there is limited evidence that this factor constitutes a risk for peri‐implantitis 7 . However, it is worth noting the increasing amount of high‐level evidence that associates inadequate KMW (<2 mm) with peri‐implant mucositis, 8,9 as well as the findings of a recent study in which a minimum amount of 2 mm of KMW was found to be critical to minimize the incidence of peri‐implant mucositis and future marginal bone loss in erratic maintenance compliers 10 .…”

In the dental implant era, why do we still bother saving teeth?

“…WebMD, a popular medical site, states that dental implants have success rates of 98%. [21][22][23][24] A dental implant with disease can hardly be called successful; however, patients do not receive this information sometimes. 19,20 However, what these sites are often reporting are the survival rates of dental implants, not necessarily success, and for a very short follow-up time.…”

“…[21][22][23][24] A dental implant with disease can hardly be called successful; however, patients do not receive this information sometimes. [21][22][23][24] This is supported by evidence that shows implant survival rates are lower than teeth, even when they are compromised but properly treated and maintained. Unfortunately, even having the dental implant as an option can, unintentionally, bias treatment planning.…”

“…The media surrounding dental implants can not only mislead patients but also mislead clinicians. [21][22][23][24]61 Despite the notion that dental implants are 99% successful, it is important to understand the current evidence and apply that information during the treatment planning process. Instead, the potential complications of placing a dental implant need to be considered and discussed starting with the surgical process itself.…”

Biologically guided implant therapy: A diagnostic and therapeutic strategy of conservation and preservation based on periodontal staging and grading

“…The contextual whole‐body diagnosis of periodontitis will also take into account the results of grading, which will identify key systemic risk factors such as diabetes and smoking. In general, the systemic risk indicators for implant placement are similar to those for periodontitis and will be revealed by the periodontal diagnosis . They need to be discussed with the patient and restorative dentist so that all parties are aware of the potential for implant failure/loss and the need for alternative treatment plans if implant failure/loss occurs.…”