Periodontal considerations in dental implantology
Featured Products Promotional FeaturesPosted by: Dental Design 14th February 2024
As a dental implant provider, it’s important to consider all of the factors which may impact the success of treatment. In particular, the aspects which may affect the peri-implant tissues. Sometimes, these factors are outside of the clinician’s control, with external risk factors playing a role. Other times, areas of the treatment protocol can have an impact on success. It’s important to make these assessments on an individual basis to devise the ideal course of treatment for every patient.
What are the risks?
Aspects outside of the clinician’s control may mean that some patients are at higher risk for dental implant failure due to peri-implantitis development. Those which have the most significant effect include poor oral hygiene, a history of periodontal disease, and smoking – with other factors such as genetics, diabetes, and alcohol consumption having a potential impact.[i] Prior to treatment, it’s important to gather all of the information needed to allow you to advise the most appropriate course of treatment to the patient. Where dental implants are still a valid option, it’s important that any potential risks are taken into account to deliver the best chance of success.
This may mean creating a modified treatment plan, offering smoking cessation advice, and encouraging patients to improve their oral hygiene routines prior to surgical treatment. The latter is particularly important as, following implant placement, it’s important to keep the surgical site free from bacteria to reduce the risk of infection and promote healing.
Things to consider
In addition to improved oral hygiene practises, there are a number of other key factors to consider to reduce the risk of peri-implantitis development. Excess cement, for example, can lead to a number of complications ranging from the temporary inflammation of the soft tissues, to severe aesthetic and functional challenges and implant loss.[ii] Additionally, an inadequate abutment-restoration seating, over-contoured prostheses, or implant malpositioning may lead to peri-implantitis.[iii],[iv] Because of this, it is vital to ensure that the prosthesis design allows for sufficient access for cleaning around the implant supported prosthesis, enabling the patient to remove plaque and bacteria. As such, the prosthesis should not be too large, as this can not only make oral hygiene difficult, but also may result in excessive occlusal forces on the dental implant.
Maintaining healthy soft tissue around a dental implant is essential for ensuring a functional, and aesthetic outcome in the long-term. The success of treatment depends on establishing peri-implant tissues which protect the bone and implant for successful osseointegration and minimal bone resorption. Healthy soft tissue is vital for achieving favourable aesthetics too, so assessing the risks, and making appropriate adaptations to meet the needs of each case, are fundamental in achieving success.[v]
Never stop learning
Dental implantology is a field which is continuously evolving and, with recent research continuing to assess the links between soft tissue health and systemic conditions,[vi] as well as the use of antibiotics to prevent post-operative complications,[vii] it is now as important as ever to keep learning. No matter what stage of your career you’re in, whether you have a well-established dental implant clinic, or are just beginning to provide dental implants, continuing to immerse yourself in education and new research is essential to ensure you’re providing your patients with the most appropriate treatment.
This being said, it’s important to understand that the many intricacies of dental implant treatment cannot be taught in a day. Mentorship and community are essential for any implantologist. No matter the amount of experience, all clinicians must be willing to learn from each other, discuss cases, and share challenges in order to grow in the field. While not exclusive to newly qualified dentists, or those new to dental implants, continuing education is particularly crucial in these formative years. Because of this, it’s important to join communities which support this idea, and inspire the next generation of implant dentists.
The Association of Dental Implantology (ADI) understands the importance of mentorship and support at all stages of a dentist’s career. By becoming a member, clinicians can benefit from access to ADI Study Clubs, dental journals and publications, as well as the ADI Register of Mentors, which allows members to become or find a mentor. In addition, the ADI hosts a number of regular Congresses, Masterclasses, and Focus Meetings, which support learning and encourage networking. Those who are early on in their implant career may also benefit from the Next Gen Committee, which is dedicated to supporting those getting into dental implants.
When providing patients with dental implant treatment, it is absolutely essential to consider all of the factors which may contribute to peri-implantitis and implant failure. In order to identify and mitigate these risks, clinicians must communicate clearly with their patients, and create a treatment plan which delivers the best possible chance of success.
For more information, please visit www.adi.org.uk
Dr. Zaki Kanaan President ADI
Dr Zaki qualified from Guy’s Hospital, London, in 1996. His main interests lie in all aspects of Cosmetic Dentistry with a special interest in Dental Implant Treatment, where he has achieved a Masters Degree from the GKT Dental Institute in 2001.
[i] The British Society of Periodontology. Accessed Nov 23:
https://www.bsperio.org.uk/assets/downloads/jcpd22_97EngUK.pdf
[ii] https://www.iti.org/academy/clinical-applications/clinical-case-report/-/case/excess-cement-resulting-in-peri-implant-infection-presenting-as-a-draining-sinus-tract/14805
[iii] Ramanauskaite A, Juodzbalys G. Diagnostic Principles of Peri-Implantitis: a Systematic Review and Guidelines for Peri-Implantitis Diagnosis Proposal. J Oral Maxillofac Res. 2016 Sep 9;7(3):e8. doi: 10.5037/jomr.2016.7308. PMID: 27833733; PMCID: PMC5100648.
[iv] Toma S, Brecx MC, Lasserre JF. Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial. J Clin Med. 2019 Jul 3;8(7):966. doi: 10.3390/jcm8070966. PMID: 31277265; PMCID: PMC6679014.
[v] Dental Implants: Periodontal Considerations. Accessed Nov 23:
[vi] Assery NM, Jurado CA, Assery MK, Afrashtehfar KI. Peri-implantitis and systemic inflammation: A critical update. Saudi Dent J. 2023 Jul;35(5):443-450. doi: 10.1016/j.sdentj.2023.04.005. Epub 2023 May 7. PMID: 37520600; PMCID: PMC10373087.
[vii] Ikram, J., Shado, R., Pereira, I.N. et al. Efficacy and safety of using antibiotics to prevent post-operative complications in oral implant treatment: evidence-based review. BDJ Open 9, 47 (2023). https://doi.org/10.1038/s41405-023-00174-4
