Periodontitis: no longer a worthy adversary?
Featured Products Promotional FeaturesPosted by: Dental Design 11th March 2023
Periodontitis is thought to be one of the most common causes of tooth loss, affecting approximately 1 billion people globally.[i] Edentulism can be incredibly distressing for the individual, physically, emotionally and socially. However, there are several restorative modalities available to replace a person’s missing teeth and restore function and confidence. This includes dental implant therapy, which as you know has become a predictable and successful restorative option. Clinicians are likely to encounter patients with a history of periodontal disease, or active periodontal disease, who would like to replace their missing teeth with dental implants. With the increased risk of complications following treatment, clinicians must exercise careful consideration when treating these patients.
Periodontitis – a complex history
Periodontitis is a widespread issue, with a myriad of potential risk factors. A characteristically ‘Western’ diet, one that is high in sugar and saturated fat, and low in fibre and unsaturated fats, can increase the risk of periodontal diseases.[ii] Additionally, periodontitis and diabetes have a bidirectional relationship, with the risks of periodontal disease increasing by approximately 2 to 3 times in diabetic individuals. For those without diabetes, but with severe manifestations of periodontitis, the risk of developing diabetes increases.[iii] Smoking can also impact the periodontal tissues, affecting not only the occurrence of periodontitis but also its progression.[iv]
In dental implantology, the overarching outcome is to achieve long-lasting stability and durability, which complications like peri-implantitis can compromise. The occurrence of peri-implantitis is difficult to gauge as the literature differs, but it is generally accepted as a common biological complication following dental implant therapy.[v] Researchers found similarities between a microbiota found in peri-implantitis pockets and periodontitis, including high levels of Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Tannerella forsythia and Aggregatibacter actinomycetemcomitans.[vi] However, recent findings suggest that the microbial community found in peri-implantitis may not be as similar to that of periodontitis as previously determined.[vii] While the topic remains controversial, the literature still largely demonstrates that a history of periodontal issues is still a potential risk factor for peri-implantitis.[viii] [ix]
Treating the issue
Prior to dental implant treatment, patients presenting with periodontitis must undergo therapy to achieve periodontal stability, reducing periodontal pockets to a state where dental implants can be placed safely. This includes encouraging behavioural changes in patients, helping them adhere to a strict maintenance programme and controlling potential risk factors.[x] As you well know, poor compliance increases the risk of the reoccurrence of periodontitis,[xi] and so patients must understand their critically important role in improving their periodontal health. During this time, patients can establish better habits that will keep the reoccurrence of oral disease at bay, helping them to adequately maintain their replacement dentition. Patients may also require either a surgical or non-surgical procedure to remove biofilm and calculus from the subgingival environment.viiBone and/or tissue grafts may be indicated if the severity of the disease has eroded the soft or hard tissues of the oral cavity.[xii]
Education equals excellence
It is unsurprising that many clinicians are wary about treating patients with a history of periodontitis with dental implants. Even after successful periodontitis therapy prior to dental implant placement, strict patient compliance cannot be guaranteed. However, patients with a history of periodontitis can still be candidates for dental implants with careful planning and consideration. As the population ages, the incidence of periodontitis and tooth loss are likely to rise, which means clinicians will be seeing an increasing number of patients who fall into these categories. Dental implantology is now an established field, with many dental practices offering this modality to patients – it follows that the education and learning opportunities for this field have improved and become broader as a result.
Clinicians today have access to first-class resources, from courses and training programmes to being able to join a dedicated organisation such as the Association of Dental Implantology (ADI). The latter provides exceptional opportunities for professionals to network, establish relationships and share ideas and cases. Here at the ADI, we also host events, providing the chance for professionals to surround themselves with like-minded peers, discover the latest concepts and techniques and find out ways to overcome common challenges. We are delighted to announce our ADI Team Congress 2023, titled ‘Dental Implants: Individual Excellence or Team Triumphs’. We have brought together the very best minds in the profession to explore topics relating to implant dentistry. Alongside inspiring speakers and riveting lectures, delegates can also peruse the exhibition floor, as well as enjoy our notorious Congress Drinks and Congress Dinner! Be sure to book your place now – the ADI Team Congress 2023 will take place at the ICC in Birmingham, 4-6 May.
Overcome any challenge
While, naturally, the topic remains debated, a history of periodontitis no longer has to disqualify a patient for dental implant treatment. A knowledgeable clinician can carefully consider the treatment pathway and help patients manage their condition prior to, during and after the procedure, to ensure that the restorative outcome is successful and long-lasting.
ADI Team Congress 2023
Dental Implants: Individual Excellence or Team Triumph
Birmingham
4-6 May 2023
ADI members can access the event at a heavily discounted rate, join today
Amit Patel – President of The Association of Dental Implantology (ADI) is registered with the General Dental Council as a specialist in periodontics.
His special interests are dental implants, regenerative and aesthetic periodontics.
Amit graduated from the University of Liverpool and completed a four year specialist training programme in Periodontics at Guy’s, King’s & St Thomas’ Dental Institute.
[i] www.who.int. (n.d.). WHO highlights oral health neglect affecting nearly half of the world’s population. [online] Available at: https://www.who.int/news/item/18-11-2022-who-highlights-oral-health-neglect-affecting-nearly-half-of-the-world-s-population#:~:text=The%20most%20common%20oral%20diseases [Accessed 14 Dec. 2022].
[ii] Martinon, P., Fraticelli, L., Giboreau, A., Dussart, C., Bourgeois, D. and Carrouel, F. (2021). Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases. Journal of Clinical Medicine, [online] 10(2), p.E197. Available at: https://pubmed.ncbi.nlm.nih.gov/33430519/ [Accessed 15 Dec. 2022].
[iii] Preshaw, P.M. and Bissett, S.M. (2019). Periodontitis and diabetes. British Dental Journal, [online] 227(7), pp.577–584. Available at: https://www.nature.com/articles/s41415-019-0794-5 [Accessed 15 Dec. 2022].
[iv] Leite, F.R.M., Nascimento, G.G., Scheutz, F. and López, R. (2018). Effect of Smoking on Periodontitis: A Systematic Review and Meta-regression. American Journal of Preventive Medicine, [online] 54(6), pp.831–841. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0749379718315745 [Accessed 15 Dec. 2022].
[v] Diaz, P., Gonzalo, E., Villagra, L.J.G., Miegimolle, B. and Suarez, M.J. (2022). What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health, [online] 22(1). Available at: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-022-02493-8 [Accessed 14 Dec. 2022].
[vi] Faveri, M., Figueiredo, L.C., Shibli, J.A., Pérez-Chaparro, P.J. and Feres, M. (2014). Microbiological Diversity of Peri-Implantitis Biofilms. Advances in Experimental Medicine and Biology, pp.85–96. doi:10.1007/978-3-319-11038-7_5.
[vii] Kumar, P.S., Mason, M.R., Brooker, M.R. and O’Brien, K. (2012). Pyrosequencing reveals unique microbial signatures associated with healthy and failing dental implants. Journal of Clinical Periodontology, [online] 39(5), pp.425–433. Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2012.01856.x [Accessed 14 Dec. 2022].
[viii] Hashim, D. and Cionca, N. (2020). A Comprehensive Review of Peri-implantitis Risk Factors. Current Oral Health Reports. [online] Available at: https://link.springer.com/article/10.1007/s40496-020-00274-2#:~:text=Established%20peri%2Dimplantitis%20risk%20factors,or%20presence%20of%20excess%20cement. [Accessed 14 Dec. 2022].
[ix] Ferreira, S.D., Martins, C.C., Amaral, S.A., Vieira, T.R., Albuquerque, B.N., Cota, L.O.M., Esteves Lima, R.P. and Costa, F.O. (2018b). Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies. Journal of Dentistry, [online] 79, pp.1–10. Available at: https://www.sciencedirect.com/science/article/pii/S0300571218305220 [Accessed 14 Dec. 2022].
[x] ITI Blog. (2021). Diagnosing and treating periodontitis prior to implant placement. [online] Available at: https://blog.iti.org/clinical-insights/diagnosing-treating-periodontitis-prior-to-implant-placement/#h-risk-indicators-for-peri-implant-diseases [Accessed 14 Dec. 2022].
[xi] Costa, F.O., Cota, L.O.M., Cortelli, J.R., Cortelli, S.C., Cyrino, R.M., Lages, E.J.P. and Oliveira, A.P.L. (2015). Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study. PLOS ONE, [online] 10(10), p.e0140847. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140847 [Accessed 15 Dec. 2022].
[xii] Yuan, Y., Zhao, J. and He, N. (2021). Observation on the Effect of Bone Grafting Alone and Guided Tissue Regeneration Combined with Bone Grafting to Repair Periodontal Intraosseous Defects. Evidence-Based Complementary and Alternative Medicine, [online] 2021, pp.1–8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526246/ [Accessed 15 Dec. 2022].
