Prevention of peri-implantitis should start at treatment planning

Abstract

The successful use of implant supported prostheses for replacement of missing teeth has been well established. However, functioning dental implants are not complication free. Late implant complications occur mostly during the prosthetic and maintenance phase, after the implants have been successfully osseointegrated. Biological complications may affect the peri-implant soft tissues only (peri-implant mucositis), or progress to involve the surrounding bone, which previously ankylosed the implant (peri-implantitis). Most literature on biological complications suggested that periimplantitis following successful osseointegration may be the result of adverse host immune response against a sub-implant crevice bacterial insult, giving rise to tissue reactions clinically similar to periodontitis. In peri-implantitis, increased peri-implant probing depths (PIPD) and bleeding on probing (BOP) are usually evident while other clinical signs may include, mucosal swelling, suppuration or even recession of periimplant mucosa. Although the diagnostic criteria of PIPD >5 mm, with positive BOP and radiographic bone loss ≥ 2 mm around dental implants have been suggested for the clinical diagnosis of peri-implantitis, more stringent parameters were recently advocated with the aim of providing guidelines for clinical management and future research. Biological and mechanical factors may potentially increase the risk of peri-implantitis. Smoking, poor oral hygiene, a history of periodontitis, very rough implant surfaces and possibly design of the implant suprastructures may complicate the progression of peri-implantitis. If left untreated, peri-implantitis may progress and eventually lead to complete loss of osseointegration and the implant concerned. A variety of nonsurgical, surgical anti-infective and regenerative therapies have been advocated for treating peri-implantitis. However recent systematic reviews of such treatment modalities report limited success in preventing peri-implantitis recurrence. Given the increased popularity of dental implants as the treatment of choice for replacement of missing teeth, more research is needed to identify effective novel treatment options to manage peri-implantitis. Prevention of peri-implant diseases should start as early as treatment planning. In this chapter, we discussed the impact of preventing and treating periodontal and peri-implant inflammation on peri-implantitis risks reduction, and highlighted the importance of managing periodontal and early peri-implant biological complications in order to prevent occurrence or progression of peri-implantitis. Mechanical considerations in terms of prostheses design, material used, occlusion, and their effect on peri-implant health was also emphasized.