Periodontal Considerations in Dental Implantology

01 December 2023 (Last updated: 1 Dec 2023 09:56)

Periodontal considerations in dental implantology

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]

References

[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: 

https://jssaherstorage.blob.core.windows.net/jssuudstorage/udpdocs/Dental%20Implants-%20Periodontal%20Considerations.pdf 

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