Collaboration: The key to peri-implantitis prevention
Featured Products Promotional FeaturesPosted by: Dental Design 18th April 2021
Dental implant treatment is an appealing option for many patients considering a restorative solution for one or several missing teeth. It has become an effective, predictable and reliable treatment modality in recent years, especially as materials, techniques and technology have advanced substantially within the field. However, dental implants are not without their complications – as the number of implants placed continues to increase, so do the prevalence rates for peri-implantitis, which is a significant risk factor for implant failure.
Like periodontitis, it is a destructive, bio-film associated disease characterised by inflammation of the peri-implant mucosa and subsequent progressive loss of supporting bone.[1] Peri-implantitis affects around 13% of implants and 18.5% of patients, with its incidence rising from 0.4% to 43.9% within 3–5 years.[2], [3] Despite its predominantly bacterial aetiology, there are various factors that may increase a patient’s risk of developing peri-implantitis. Identifying and addressing these factors before implants are considered is essential to disease prevention and treatment.
The patient
It is extremely important to the consent process and the overall success of treatment that patients fully understand what placing and restoring a dental implant entails. The Association of Dental Implantology (ADI) offers prospective implant patients a valuable resource of information in the form of its “Considering Dental Implants?” leaflet.[4] This includes a section on various myths about treatment, with the top two being that “Dental implants last for life” and “You don’t need to clean them”, suggesting that these are commonly misheld beliefs among some patients.
As many professionals would agree, dental implants are like any other restoration in that they need to be cared for to ensure their longevity. Although dental implants are not forever, they can certainly last many years through professional intervention – involving regular assessments and maintenance treatment – combined with diligent daily cleaning at home. Given the importance of oral hygiene on treatment success, it is vital that patients are educated on how to look after their dental implant properly and their expectations effectively managed to ensure they are realistic.
Patients should also be informed about the potential treatment impact of a smoking habit, a history of periodontitis, medications that the patient may be taking, and systemic conditions such as uncontrolled diabetes – all of which are risk factors for peri-implantitis, alongside a lack of effective oral care.[5] Professional support can be provided to help patients mitigate these risks, but it is important to have open, honest and transparent discussions about treatment in order to ensure patients understand, appreciate and accept their role in peri-implant disease prevention.
The dental team
It goes without saying that practitioners should be suitably trained to safely and effectively perform dental implant treatment to a consistently high standard. After all, the skill of a clinician can play a significant role in the chances of complications arising, with implant survival rates dropping to just 73% when placed by an inexperienced practitioner.[6]
The techniques employed to place and restore a dental implant can also influence the final result. For instance, clinicians may select a cement-retained as opposed to a screw-retained restoration for a particular case, but it is important that they understand how to manipulate the material to ensure there is no excess cement left behind during placement, which can increase the risk of peri-implantitis.[7]
As a dentist, you can utilise the expertise of a dental hygienist to promote optimal patient compliance with treatment. A dental hygienist will not only be able to help in maintaining the implant through professional intervention, but also in promoting positive habits among patients, especially in relation to smoking cessation and following a healthy diet. Furthermore, a dental hygienist can support you in motivating and reinforcing patient education on daily implant maintenance, which should begin prior to treatment and immediately post-placement as part of a regular, tailored recall regime.
Should a case present where peri-implant disease has developed, rest assured that you can always refer to a trusted clinic like Ten Dental+Facial for additional support. Adhering to stringent infection control measures and social distancing guidelines, the multi award-winning team accepts referrals for both simple and advanced implant cases, including those where peri-implantitis is present. You can be confident that any patients you refer to the highly skilled and experienced team will be treated with utmost care, before they are returned to you for on-going review and follow-up treatment.
Dental implants are a safe, reliable and predictable alternative to traditional restorative solutions such as dentures. Nevertheless, while an implant-supported restoration can provide highly aesthetic and functional results similar to that of a natural tooth, its long-term success depends on the careful planning, proper execution and consistent maintenance. The most desirable results can only be achieved through effective collaboration between the patient and the dental team.
For more information visit www.tendental.com, email referrals@tendental.com or call on 020 8675 1798
Author: Martin DR MARTIN WANENDEYA
BDS (U Brist) DipImpDent RCS (Eng) (Adv. Cert) (GDC: 70626) Implant Surgeon
Co-owner of Ten Dental+Facial Practice
[1] Berglundh, T. et al. (2018) Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 45(Suppl 20): S286–S291. DOI: 10.1111/jcpe.12957.
[2] Rakic, M. et al. (2018) How frequent does peri-implantitis occur? A systematic review and meta-analysis. Clin Oral Investig. 22(4): 1805–16. DOI: 10.1007/ s00784-017-2276-y.
[3] Dreyer, H. et al. (2018) Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res. 53(5): 657–81. DOI: 10.1111/jre.12562.
[4] Association of Dental Implantology. (2021) Considering Dental Implants?. Available at: https://consideringdentalimplants.co.uk/. [Last accessed: 05.02.21].
[5] Hashim, D. and Cionca, N. (2020) A Comprehensive Review of Peri-implantitis Risk Factors. Curr Oral Health Rep. 7: 262–273. DOI: 10.1007/s40496-020-00274-2.
[6] Morris, H. F. and Ochi, S. (2000) Influence of Two Different Approaches to Reporting Implant Survival Outcomes for Five Different Prosthodontic Applications. Annals of Periodontology. 5(1): 90–100. DOI: 10.1902/annals.2000.5.1.90.
[7] Staubli, N. et al. (2017) Excess cement and the risk of peri-implant disease – a systematic review. Clin Oral Implants Res. 28(10): 1278–1290. DOI: 10.1111/clr.12954.
