Radiographic evaluation of modern oral implants with emphasis on crestal bone level and relevance to peri‐implant health

Abstract

Implant stability and maintenance of stable crestal bone level are prerequisites for the successful long-term function of oral implants, and continuous crestal bone loss constitutes a threat to the longevity of implant-supported prosthetic constructions. The prevalence/incidence and reasons for crestal bone loss are under debate. Some authors regard infection (i.e. peri-implantitis) as the cause for virtually all bone loss, while others see crestal bone loss as an unavoidable phenomenon following surgery and implant loading. Irrespective of the cause of continuous crestal bone loss, correct usage and scientifically sound interpretation of radiographs are of utmost importance for evaluation of oral implants. The periapical radiographic technique is currently the preferred method for evaluating implant health based on bone loss, and digital radiographs allow easy standardization of the image contrast. It is suggested that baseline radiographs should be taken at the time the transmucosal part pierces the mucosal tissues and annually thereafter. The number of unreadable radiographs should be presented in scientific publications to give insights into the quality of the radiographic examination. It is suggested that not only mean values, but also the range of bone levels, should be presented to describe the proportion of implants that show continuous crestal bone loss. In the absence of other clinical symptoms, bleeding on probing around implants seems to be a weak indicator of ongoing or future loss of crestal bone. According to recent longitudinal studies on modern implant surfaces peri-implantitis defined as 'infection with suppuration associated with clinically significant progressing crestal bone loss' occurs with a prevalence of less than 5 % in implants with 10 years in function.

How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review

“…De Bruyn, Vandeweghe, Ruyffelaert, Cosyn and Sennerby (2013) reviewed radiographic assessment of modern implants and suggested that this mean bone loss assessment in patients with multiple implants yields very limited information on the condition of individual implants. However, it may be valid to benchmark implant systems.…”

Taller 5 - Peri-implantitis

“…The main disagreement was on when the initial x-ray should be taken: when the implant is placed, when the restoration is placed or after bone remodeling. This workshop found greater scientific evidence, as well as agreement among authors, supporting initial radiographic examination, after postrestoration bone remodeling (11,13,14) .…”

“…La discrepancia fundamental se centra en la oportunidad de obtener la radiografía inicial: al momento de la colocación del implante, cuando se instala la rehabilitación o posterior al remodelado óseo. Este taller encontró mayor evidencia científica, así como coincidencia entre los autores, que sugieren el control radiográfico inicial, luego del remodelado óseo post rehabilitación (11,13,14) .…”

Evaluation of Peri-Implant Bone Reduction Levels from Superimposition Perspective: Pilot Study among Ukrainian Implantology Practice

“…Radiographical methods remains the most widely used in the different modification to evaluate peri-implant bone level changes [13,14,16]. In the course of this study, it was found that the level of bone resorption after one year of implant functioning could be established according to the data obtained from digital sagittal cross section of CBCT results, because this method by its methodology of evaluation does not different from those one with the use of periapical X-ray images.…”

“…The most widely used method is periapical radiography, but such method still is operator sensitive and not enough reliable [9,12,13]. On the other hand, such method allows only registering bone changes from the medial and distal sides of dental implant, and does not include the possibility to find out the exact volume of circular bone loss around intraosseous titanium element.…”