It’s essential to consider peri-implant tissue health when devising treatment plans for successful rehabilitation. After a patient has undergone implant placement, it is then important to monitor the recovery of the soft tissue, and the quality of their oral health and hygiene in the years to come.
Peri-implantitis, the infection of the implant site that results in inflammation of the soft tissue and bone loss,[i] is one of the most well-known risk factors for late implant failure due to biological complications.[ii]
Any dental professional treating patients with an implant must be able to recognise the presence of peri-implantitis, and action an effective treatment plan to prevent its progression that will be detrimental to the implant and/or the surrounding dentition. Better yet, clinicians should be able to recognise how peri-implant tissue care can be optimised to prevent the development of the infection in the first place.
Peri-implant disease management
Peri-implantitis affects 15-57% of patients and 8-28% of implants.[iii] The key to preventing peri-implantitis is the same as preventing other periodontal diseases like gingivitis or periodontitis – patients must exercise good oral hygiene at home.[iv] The literature cites patient-administered mechanical plaque control as the current standard of care, with oral rinses or a dentifrice having a positive, albeit limited, adjunctive effect.[v] Clinicians can not only reinforce this habit before and after implant treatment, but can provide support by employing professional mechanical plaque debridement with different hand or powered instruments, with or without polishing tools.v
A previous history of periodontal disease has been strongly associated with peri-implantitis, and active infection at the site of adjacent teeth is further considered a predictor of future peri-implantitis. In fact, patients with a history of generalised aggressive periodontitis are 5 times more prone to implant failure, and up to 14 times more susceptible to peri-implantitis.[vi] This could inform a patient’s suitability for treatment, and reinforces the need for individuals to keep an effective oral hygiene routine.
It’s of no surprise that smoking has a negative effect on peri-implant tissue, much in the same way that it affects conventional periodontal health. Smokers have almost double the risk of developing peri-implantitis compared to non-smokers, and the habit is associated with increased severity of peri-implantitis lesions.vi Clinicians could try to help patients cease their smoking habits long before the implant is placed, which would ensure the peri-implant tissue has the greatest opportunity to be healthy. Where this is not possible, any attempts to cut back on a smoking habit should be supported and commended by dental professionals.
Understanding augmentation
Clinicians should also explore the merits and impacts of soft tissue augmentation. Where soft tissue volume is inadequate, autogenous soft tissue grafts or effective substitutes can be utilised.
Historically, autogenous grafts have been preferred, with positive results in increasing keratinised tissue – which, when not present, can increase the susceptibility of peri-implant tissue destruction – and gingival thickness around dental implants.[vii] However, autogenous grafts require a second surgical donor site, which is associated with increased post-operative bleeding, tissue necrosis and discomfort, and there may be a limited availability of autogenous grafts due to anatomical limitations.vii
Alternative solutions, such as acellular dermal matrices or xenogeneic collagen matrices, have been proven to increase keratinised mucosa width and mucosal thickness, with significant improvements when compared to non-augmented sites.vii Xenogeneic collagen matrices, in particular, have been recognised as advantageous due to their unlimited supply, less invasive treatments, no donor site morbidity, and reduced surgical time.[viii]
Soft tissue augmentation is a brilliant workflow to learn for clinicians who routinely provide dental implants, or have extensive experience in doing so.
Developing soft-tissue skills
Clinicians that are providing dental implants or are treating patients with such restorations must be aware of how they can enhance peri-implant soft tissue health and care. By developing their knowledge in these areas, and acquiring new skills such as soft tissue augmentation, the rising demand[ix] for dental implants can be met with effective solutions.
Dental professionals could undertake Management of Soft Tissue with No Issue, a one-day course from One to One Implant Education, supported by Megagen, to further their knowledge. Delegates will develop their understanding of the anatomy of peri-implant soft tissue, as well as their ability to identify and diagnose common peri-implant diseases. They will also gain practical skills in performing procedures for soft tissue augmentation, with the ability to apply their learning in clinical practice. Led by the renowned Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis, it’s the perfect opportunity to enhance their patient care.
The complete success of dental implant treatment, with patients benefiting from optimal aesthetics, function and longevity, relies strongly upon soft tissue health. Clinicians should always look to develop their knowledge to ensure patients have the best possible chance of preventing peri-implantitis, or undergo soft tissue augmentation when it is most appropriate.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000
Authors: Dr Nikolas Vourakis & Dr Fazeela Khan-Osborne
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.
Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
Nikolas is a Senior Implant and Restorative Surgeon in private clinics in London and Edinburgh.
His special interest and main qualifications are in Oral Surgery and Oral Implantology, while he has vast experience in all areas of Aesthetic Dentistry.
He has been a practising Dental Surgeon since 2005 after graduating from the prestigious Military Academy Medical School at the University of Thessaloniki, Greece.
Nikolas started his training in the Oral and Maxillofacial Surgery Department of the 401 Military Hospital in Athens, Greece. As a military officer, he then went on to serve as a team leader in a field hospital in Kabul, Afghanistan – an experience, which shaped his commitment and dedication to his chosen field. On returning to Greece, he furthered his
training completing a Postgraduate Diploma in Oral Implantology from the University of Athens, Greece and a Master of Science Degree in Oral Surgery/Implantology from Göethe University of Frankfurt, Germany.
He recently obtained an Advanced Surgical Master Curriculum in Regenerative Implant Dentistry next to Dr Istvan Urban in Budapest, Hungary.
Nikolas is lecturing about Dental Implants and Regenerative Dentistry, and he is holding a program for introducing and mentoring dentists in Implant Dentistry.
He is a Member of the Association of Dental Implantology and the International Team for Implantology.
[i] Prathapachandran, J., & Suresh, N. (2012). Management of peri-implantitis. Dental research journal, 9(5), 516.
[ii] Do, T. A., Le, H. S., Shen, Y. W., Huang, H. L., & Fuh, L. J. (2020). Risk factors related to late failure of dental implant—A systematic review of recent studies. International journal of environmental research and public health, 17(11), 3931.
[iii] Schwarz, F., & Ramanauskaite, A. (2022). It is all about peri‐implant tissue health. Periodontology 2000, 88(1), 9-12.
[iv] European Federation of Periodontology, (2024). Peri-implant disease: Prevention. (Online) Available at: https://www.efp.org/for-patients/dental-implants/peri-implant-disease-prevention [Accessed July 2024]
[v] Jepsen, S., Berglundh, T., Genco, R., Aass, A. M., Demirel, K., Derks, J., … & Zitzmann, N. U. (2015). Primary prevention of peri‐implantitis: Managing peri‐implant mucositis. Journal of clinical periodontology, 42, S152-S157.
[vi] Hashim, D., & Cionca, N. (2020). A comprehensive review of peri-implantitis risk factors. Current Oral Health Reports, 7, 262-273.
[vii] Sun, T. C., & Chang, T. K. (2024). Soft tissue management around dental implant in esthetic zone–the current concepts and novel techniques. Journal of Dental Sciences.
[viii] Bevilacqua, L., Pipinato, G., Perinetti, G., Costantinides, F., Rizzo, R., & Maglione, M. (2020). The use of a xenogenic collagen matrix (Mucograft®) in the treatment of the implant site: a literature review. Frontiers of Oral and Maxillofacial Medicine, 2, 1-11.
[ix] Chin, J. S., Rees, J., & Addy, L. (2020). The provision of dental implants: current practice among university and hospital specialists in restorative dentistry within the UK and Ireland. British Dental Journal, 228(1), 39-43.
