As one of the leading, avoidable causes of dental implant failure,[i] a great deal of consideration is given to the likelihood of patients developing peri-implant diseases (PID) before considering implants as a treatment option. Failure to assess the probability of serious infection comes with a huge cost. Implants are a significant investment for many patients, coming at a cost that for some means difficult decisions around their financial planning. Retreatment may well represent real economic hardship, and may be out of reach for some patients.[ii]
There is also an important sustainability component to prevention that is increasingly accepted within the dental profession. Preventative treatment means less patient travel, less use of non-renewable or non-biodegradable materials and less output of energy.[iii]
Every clinician providing implant treatment has a responsibility to prevent disease, or unnecessary treatment. With the right approach and correct risk mitigations, professionals can greatly improve the predictability of their practice.
Standardising guidelines around prevention
A number of recommendations and guidelines exist to provide a clear decision-making process for the prevention and treatment of PIDs. Initiatives like the European Federation of Periodontology (EFP) S3-Level clinical practice guidelines[iv] aim to standardise care to ensure patients’ needs are met. These evidence-based guidelines also serve to help demonstrate clearly to at-risk patients what measures they can take to enable implant treatment to move forward, and to maintain success.
Recommendations emphasise preventative measures as soon as dental implants are suggested as a possible treatment; an interdisciplinary approach in planning, surgical placement and prosthetic design; identifying all local and systemic risk factors that can contribute to PIDs in a complete risk assessment; and patient education, emphasising the vital role of enhanced oral hygiene routines at home, as well as regular follow-up visits to the dentist.[v]
Every patient should be considered at-risk of developing PID. Once the implants have been placed, patients should receive a tailored supportive peri-implant care (SPIC) programme for enhanced oral hygiene coaching and early detection of problems.
Pathophysiology and prevalence
Peri-implant biofilms are thought to be the primary cause of peri-implant mucositis, the largely treatable precursor of peri-implantitis.[vi] There are similarities between periodontal diseases and PIDs. However, unlike periodontal tissues, peri-implant tissues do not contain cementum or periodontal ligaments, leaving only the alveolar bone and the peri-implant mucosa. In the peri-implant mucosa, epithelial attachment tends to be longer, the connective tissue lacks fibres that insert into the supra-crestal area, and it has lower vascularisation. PIDs have been shown to result in faster and more significant bone resorption than periodontal disease.[vii]
During the XI European Workshop in Periodontology in 2014, a systematic review was conducted to examine the prevalence of PIDs. This review analysed eleven studies and found that about 43% of patients experience peri-implant mucositis. For peri-implantitis, the prevalence was about 22%. It has been found that patients with peri-implant mucositis who do not receive regular supportive therapy are at a higher risk of developing peri-implantitis. Another key finding was that patients could effectively reduce their risk by maintaining good oral hygiene. [viii]
Assessing the risk
A comprehensive approach to assessing risk is a vital element to improve outcomes in implant treatment. The periodontal risk assessment,[ix] a spider-web shaped matrix including an evidence-based range of risk factors for PID, is an effective tool to make the decision-making process safer and more predictable. It includes six key factors, which are important indicators of risk, including the bleeding on probing score, the presence of gum pockets measuring 5 mm or deeper, and the number of missing teeth. Additionally, it assesses the risk of infection and other risks to osseointegration in relation to factors such as the patient’s age, systemic and genetic factors, and tobacco use.
Micromovements and peri-implant disease
Many risk factors for peri-implant disease are associated with oral dysbiosis, making infection more likely. In addition, poor bone quality can result in mechanical instability creating a risk of exposure of implants to the oral microenvironment. Bacteria adhering to the implant surface can easily form biofilms which can influence the implant in various ways. Lack of implant stability due to mechanical overloading or inappropriate implant/abutment connection can result in micromovements that leave gaps, perfect for the proliferation of harmful bacteria.[x]
Risk reduction is further assisted by using the right tools both to insert implants and measure their stability. The automatic thread cutter function of the Implantmed from W&H prevents excessive compression of the bone, promoting stress-free healing. Implantmed Plus connects seamlessly to the Osstell Beacon, which objectively measures implant stability, and enables clinicians to monitor osseointegration over time, without jeopardising the healing process. Take a look at the W&H synergistic surgical solution to provide the complete answer to providing implant treatment.
Preventing implant failure is greatly assisted by a proactive, evidence-based approach, that takes risk factors into consideration from the outset. Using these tools, while fully informing and educating patients on what they can do to prevent failure greatly improves outcomes.
To find out more about the full range from W&H, visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com
Author – Jon Bryant General Manager W&H UK
[i] Kochar SP, Reche A, Paul P. The Etiology and Management of Dental Implant Failure: A Review. Cureus. 2022 Oct 19;14(10):e30455. doi: 10.7759/cureus.30455. PMID: 36415394; PMCID: PMC9674049.
[ii] Alani, A., Kelleher, M., & Bishop, K. (2014). Peri-implantitis. Part 1: Scope of the problem. British Dental Journal, 217(6), 281–287. https://doi.org/10.1038/sj.bdj.2014.808
[iii] Clinical guidelines for environmental sustainability in dentistry. Royal College of Surgeons. January 2023. Available at: https://www.rcseng.ac.uk/-/media/fds/clinical-guidelines-for-environmental-sustainability-in-dentistry-version-110.pdf. Accessed March 2025
[iv] Herrera, D., Berglundh, T., Schwarz, F., Chapple, I., Jepsen, S., Sculean, A., Kebschull, M., Papapanou, P. N., Tonetti, M. S., Sanz, M., & on behalf of the EFP workshop participants and methodological consultant (2023). Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 50(S26), 4–76. https://doi.org/10.1111/jcpe.13823
[v] Herrera, D., Berglundh, T., Schwarz, F., Chapple, I., Jepsen, S., Sculean, A., Kebschull, M., Papapanou, P. N., Tonetti, M. S., Sanz, M., & on behalf of the EFP workshop participants and methodological consultant (2023). Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 50(S26), 4–76. https://doi.org/10.1111/jcpe.13823
[vi] Herrera, D., Berglundh, T., Schwarz, F., Chapple, I., Jepsen, S., Sculean, A., Kebschull, M., Papapanou, P. N., Tonetti, M. S., Sanz, M., & on behalf of the EFP workshop participants and methodological consultant (2023). Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 50(S26), 4–76. https://doi.org/10.1111/jcpe.13823
[vii] Wada M, Mameno T, Otsuki M, Kani M, Tsujioka Y, Ikebe K. Prevalence and risk indicators for peri-implant diseases: A literature review. Jpn Dent Sci Rev. 2021 Nov;57:78-84. doi: 10.1016/j.jdsr.2021.05.002. Epub 2021 Jun 8. PMID: 34158874; PMCID: PMC8203834.
[viii] Herrera, D., Berglundh, T., Schwarz, F., Chapple, I., Jepsen, S., Sculean, A., Kebschull, M., Papapanou, P. N., Tonetti, M. S., Sanz, M., & on behalf of the EFP workshop participants and methodological consultant (2023). Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 50(S26), 4–76. https://doi.org/10.1111/jcpe.13823
[ix] Farina R, Lopez R, Simonelli A, Trombelli L. Accuracy and applicability of periodontitis risk assessment tools: A critical appraisal. Periodontol 2000. 2023; 00: 1-18. doi:10.1111/prd.12498
[x] Chen, L., Tong, Z., Luo, H. et al. Titanium particles in peri-implantitis: distribution, pathogenesis and prospects. Int J Oral Sci 15, 49 (2023). https://doi.org/10.1038/s41368-023-00256-x
