Dental implantation is a long-practiced treatment for restoring function and aesthetics to the oral cavity, dating back to ancient times. For the treatment to work, a surviving implant must remain in the bone, be stable, and be functionally successful.[i] Despite being effective as a treatment for edentulism, implant failure can occur in either short-term or long-term capacities if the risks are not reduced.
Such factors for implant failure can include selecting an alveolar bone site of inadequate quality, if the patient is a strong bruxist, or if they have poor oral hygiene.i Whilst these factors can be controlled to an extent, peri-implant diseases can be a major barrier to treatment success and can be influenced by factors that are much harder to navigate or identify.
Finding the root
Biology can play a major role in peri-implant diseases, with certain genetics and systemic diseases increasing the risk of peri-implant mucositis and peri-implantitis. Peri-implant diseases are long-term risk factors for treatment failure and understanding their aetiological history is essential to provide implant treatments that last.
Peri-implant diseases are inflammatory reactions from soft tissues that encircle a dental implant.[ii] They are multi-factorial, with the predominant causes being biological – (patients over the age of 60 are 3.2 times more likely to be diagnosed with them), biomechanical, clinical or relating to the lifestyle choices of the patient.ii For example, patients who have a poor diet and fail to maintain a consistent oral hygiene routine are more at risk.ii
Peri-implant mucositis has a higher prevalence than peri-implantitis, ranging from 29.48% to 46.83%[iii], but is also associated with an increased risk of becoming peri-implantitis.iii It is reversible through early treatment if its cause is identified and eliminated.iii However, dentists must work around certain biological factors to ensure treatment success.
Genetics
Research into genetics as a factor for peri-implant diseases has often been inconclusive. Focus is drawn to the polymorphisms in the interleukin (IL) 1 gene cluster, with studies finding an association with periodontitis, a risk factor for peri-implant diseases.[iv] Moreover, the IL-1 genotype has a synergistic effect with cigarette use that can be detrimental to implant success.ii Prevalence of peri-implantitis among smokers is 36.3%, almost double the rate compared to non-smokers.iv It is therefore vital to discourage smoking for patients with implants as it can boost the risk of treatment failure.
As an inflammatory cytokine, the presence of IL-23 may add to the inflammation around an implant and can lead to impaired osseointegration and subsequent bone loss, undermining the stability of the implant.[v] Cytokines may be crucial for the future as they can also act as a diagnostic tool; genetic polymorphisms are promising paths for new drugs to act on to help with treatments.[vi]
Systemic diseases
Systemic diseases have been found to have negative effects on implant success. Such diseases include diabetes mellitus, scleroderma, ectodermal disease, lichen planus, osteoporosis, rheumatoid arthritis, and Sjögren’s syndrome.
For diabetic patients, one of the more prevalent diseases, patient awareness and glycemic control should be taken into consideration when implant therapy is needed.ii By detailing the impact that diabetes can have on implant treatment, dentists can help encourage patients to maintain well-controlled insulin levels, as poor metabolic control provides more favourable environments for infection.ii Identifying patients with, or at risk of, systemic diseases is vital for better treatment planning so that long-term treatment success is ensured.
The path to implant success
Alongside better implant treatment planning, complication risk can be decreased by creating an awareness of systemic issues and communicating with the patients who are more at risk of peri-implant diseases. The use of more effective diagnostic tools, from instruments that assess implant stability to surgical guides, can help dentists achieve more predictable outcomes for implants that last.[vii]
Consider the W&H surgical range for an array of first-class equipment including the Implantmed Surgical motor, Piezomed piezo surgery unit and the Osstell Beacon for measuring implant stability. From effortless bone cutting to assessing the stability of an implant, their ecosystem of innovative instruments and equipment can support your implant treatments. For over 30 years W&H has placed people as their priority. They are recognised for their quality advice and after-sales support, working with Key Opinion Leaders to run training courses and providing a team of efficient service engineers to ensure your equipment is always working at its best. By using W&H, you can revolutionise minimally invasive surgery that is maximally effective.
Peri-implant diseases can limit the lifespan of a successful implant. Whilst some of the factors for these diseases can be prevented or minimised, genetics and systemic diseases cannot. In these circumstances, raising awareness of these impacts can help secure the long-term success of implant treatment.
To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com
[i] Dioguardi, M., Spirito, F., Quarta, C., Sovereto, D., Basile, E., Ballini, A., Caloro, G.A., Troiano, G., Lo Muzio, L. and Mastrangelo, F. (2023). Guided Dental Implant Surgery: Systematic Review. Journal of Clinical Medicine, [online] 12(4), p.1490. doi:https://doi.org/10.3390/jcm12041490.
[ii] Mumcu, Emre & Fadhil, Sadeq. (2018). The role of etiologic factors causing peri-implantitis; A current update. 10.13140/RG.2.2.34223.15529. Accessed via: https://www.researchgate.net/publication/328956304_The_role_of_etiologic_factors_causing_peri-implantitis_A_current_update
[iii] Rokaya, D., Srimaneepong, V., Wisitrasameewon, W., Humagain, M. and Thunyakitpisal, P. (2020). Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. European Journal of Dentistry, 14(4). doi:https://doi.org/10.1055/s-0040-1715779.
[iv] Cardoso, J.M., Ribeiro, A.C., Palos, C., Proença, L., Noronha, S. and Alves, R.C. (2022). Association between IL-1A and IL-1B gene polymorphisms with peri-implantitis in a Portuguese population—a pilot study. PeerJ, 10, p.e13729. doi:https://doi.org/10.7717/peerj.13729.
[v] Talib, E.Q. and Taha, G.I. (2024). Involvement of interlukin-17A (IL-17A) gene polymorphism and interlukin-23 (IL-23) level in the development of peri-implantitis. BDJ Open, [online] 10(1), pp.1–8. doi:https://doi.org/10.1038/s41405-024-00193-9.
[vi] Chmielewski, M. and Pilloni, A. (2023). Current Molecular, Cellular and Genetic Aspects of Peri-Implantitis Disease: A Narrative Review. Dentistry journal, 11(5), pp.134–134. doi:https://doi.org/10.3390/dj11050134.
[vii] Kochar, S.P., Reche, A. and Paul, P. (2022). The Etiology and Management of Dental Implant Failure: A Review. Cureus. doi:https://doi.org/10.7759/cureus.30455.
