Prevention is crucial , at all stages
“ Control of risk indicators may limit periimplantitis and eventually implant loss .”
Giovanni E . Salvi | Switzerland Associate Professor , Vice Chairman and Graduate Program Director University of Bern , School of Dental Medicine
Interview conducted by Marjan Gilani
“ Biological complications around implants are a reality we need to face ,” says Giovanni Salvi , associate professor in the department of periodontology at the University of Bern . He believes clinicians can prevent implants from reaching the final stage of peri-implantitis , if problems are detected early .
Prof . Salvi , explantation is an emotional burden for patients . How often do implants fail ?
Prof . Salvi : Early implant loss happens in about 1 – 2 % of cases when the process of osseointegration is disturbed .¹ This may occur because of reasons such as lack of primary stability , infection after placement or unintentional early loading . Late implant failures , on the other hand , may occur because of late diagnosis and lack of treatment of peri-implantitis .
Peri-implantitis is an inflammatory disease initiated by bacterial biofilms . It is characterized by the presence of bleeding on probing ( BoP ) and / or suppuration , increased probing depths compared to previous examinations and by the presence of bone loss beyond normal crestal bone level changes resulting from initial bone remodeling .²
The reported prevalence of peri-implantitis ranges from 1 to 47 % ( mean 22 %).³ However , the wide range of reported prevalence in the literature reflects the high heterogeneity of clinical and radiographic thresholds adopted for disease definition , which makes a precise estimate of the prevalence of peri-implantitis difficult .
“ When we let an implant reach the final stage of periimplantitis , no one can perform a miracle to save it .”
What is the key to peri-implantitis control ?
Several risk indicators have been identified that may lead to the establishment and progression of peri-implantitis . Hence , control of such risk indicators may limit peri-implantitis and eventually implant loss . These risks may include poor self-performed plaque control⁴ , tobacco consumption⁵ , history of treated periodontitis⁶ , restorations with inadequate access for plaque control⁷ , presence of excess cement⁸ , lack of compliance with regular supportive care⁹ – ¹ ⁰ and lack of treatment of peri-implant mucositis ¹¹.
Can all implants be saved following peri-implantitis therapy ?
Unfortunately , not all implants can be saved in the long-term following therapy for peri-implantitis . For example , 5-years following surgical therapy of peri-implantitis with open flap debridement , adjunctive systemic antimicrobials and regular supportive care , implant loss was still observed in 17 % of cases .¹²
How do you proceed when explantation is the only option ?
Implants having completely lost osseointegration are mobile and can be explanted without having to raise a mucoperiosteal flap . Hence , from a diagnostic
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