No implantology without periodontology – Kate Scheer – W&H UKFeatured Products Promotional Features
Posted by: The Probe 6th January 2019
Dental implants have become an indispensable part of modern dentistry as an effective treatment modality for severely damaged or missing teeth. High implant success rates of 84% after 10 to 18 year follow-ups have been observed – even in high-risk patients – which suggests that implants are both safe and predictable in the vast majority of cases.[i]However, as with any other major dental procedure, complications can occur post-surgery, which could put the implant at risk of loss or failure. The latest scientific research indicates that peri-implant disease is one of the most common complications associated with dental implant procedures, which is why strategies for the prevention and management of this condition are essential in current practice.[ii]
Healthy peri-implant tissue plays an important role as a biological barrier to microbes that can cause peri-implant diseases, which are defined as inflammatory lesions of the hard and soft tissue surrounding an implant. This is a result of bacterial infection as the implant is exposed to the oral environment. Following placement, the surface of an implant is immediately covered by a layer of protein – the salivary pellicle – which is colonised by microorganisms that form a microbial biofilm. If the bacteria builds up, it can manifest as peri-implant mucositis, which can then progress into peri-implantitis, detrimentally affecting the bone structure supporting an implant. This is evident even in cases of successful osseointegration, which is vital to ensuring an implant’s long-term stability and survival.[iii]
Mobelli et al. revealed that peri-implantitis is prevalent in approximately 10% of all implants placed and in 20% of all implant patients, emphasising the importance of effective maintenance protocols as part of the treatment planning process.[iv]Each patient should be assessed against the various risk factors for the development of peri-implantitis, including:
- Smoking habits
- History of periodontal disease
- Poor compliance towards oral hygiene
- Systemic conditions (e.g. diabetes, cardiovascular disease, immunosuppression)
- Iatrogenic infection caused by dental cement
- Soft tissue defects at the surgical site (e.g. lack of keratinised gingiva)
- History of one or more implant failuresii
As reported by Heitz-Mayfield, patients who smoke or have a history of periodontitis are at the highest risk of peri-implantitis.[v]In fact, smoking has been shown to be a predictor for implant failure. Smokers also show significantly more marginal bone loss following implant placement compared to non-smokers.[vi]The conclusion that patients with a history of periodontal disease are more susceptible to peri-implantitis may be attributed to the fact that periodontal pockets can serve as bacterial “reservoirs” in partially edentulous patients. These reservoirs facilitate the transmission of periodontal pathogens from adjacent teeth to an implant. Therefore, elimination of these reservoirs prior to surgery is necessary in order to prevent bacterial infections that could threaten the implant’s survival.[vii]
One of the primary aims of peri-implant therapy is to detoxify the contaminated implant surface, which can prove challenging to do in some cases and may involve employing a multidisciplinary approach in several stages.[viii]Much of the literature covering strategies for peri-implantitis therapy is generally based on treatments for periodontal disease, due to the fact that bacterial colonisation on natural dentition is similar to that on an implant surface.[ix]As such, surface debridement constitutes as the basic element of treatment for the early indication of peri-implant diseases. However, where intervention is required, practitioners should avoid using products or materials that could damage the implant component and increase the likelihood of bacterial adhesion.
In the event that plaque accumulates over time, mechanical debridement alone may be ineffective and may not guarantee the complete removal of all adhering microorganisms. Consequently, adjunctive peri-implant therapies such as antibiotics and antiseptics, as well as ultrasonic and laser treatments, are suggested to improve conservative approaches employed as part of treating peri-implant diseases. Surgical therapy with resective and augmentative procedures can offer a comprehensive approach to treatment in advanced cases of peri-implantitis. These measures should be in addition to good at-home oral care from the patient, which involves twice-daily brushing and flossing with non-abrasive products, in order to prevent damaging the implant.
Ideally, practitioners should invest in cost-effective and time-efficient systems that can facilitate the delivery of modern implant maintenance protocols. Leading manufacturer, W&H, offers an all-inclusive prophylaxis solution through its extensive range of products. This not only includes the innovative Proxeo air scaler and the new Proxeo TWIST rotary polishing handpiece, but also the Pyon 2, the Tigon, and the Tigon+ piezo scalers. These can be customised with W&H’s new range of sophisticated implant maintenance tips, which have been specifically engineered for cleaning implants and their associated suprastructures and restorations. By taking advantage of advanced solutions such as these, practitioners can safely clean implants to an exceptionally high standard. This will help reduce the risk of peri-implant diseases for the benefit of achieving a successful long-term outcome following implant placement.
[i]De Angelis, F., Papi, P., Mencio, F., Rosella, D., Di Carlo, S. and Pompa, G. (2017) Implant survival and success rates in patients with risk factors: results from a long-term retrospective study with a 10 to 18 years follow-up. Eur Rev Med Parmacol Sci. 21(3): 433-437.
review. Head & Face Medicine, 10: 34. Link: http://doi.org/10.1186/1746-160X-10-34. [Last accessed: 01.08.18].
[iii]Parithimarkalaignan, S. and Padmanabhan, T. V. (2013) Osseointegration: An Update. The Journal of the Indian Prosthodontic Society. 13(1): 2–6. Link: http://doi.org/10.1007/s13191-013-0252-z. [Last accessed: 01.08.18].
[vi]Kasat, V. and Ladda, R. (2012) Smoking and dental implants. Journal of International Society of Preventive & Community Dentistry. 2(2): 38-41. Link: http://doi.org/10.4103/2231-0762.109358. [Last accessed: 01.08.18].
[vii]Wen, X., Liu, R., Li, G., Deng, M., Liu, L., Zeng, X-T. and Nie, X. (2014) History of Periodontitis as a Risk Factor for Long-Term Survival of Dental Implants: A Meta-Analysis. Int J Oral Maxillofac Implants. 29: 1271-1280.
[viii]Valderrama, P., Blansett, J. A., Gonzalez, M. G., Cantu, M. G. and Wilson, T. G. (2014) Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Non-surgical Methods. The Open Dentistry Journal. 8: 77–84. Link: http://doi.org/10.2174/1874210601408010077. [Last accessed: 01.08.18].
http://doi.org/10.4103/0972-124X.107466. [Last accessed: 01.08.18].