Page 13 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

Achieving osseointegration of a dental implant is no longer the key issue in research related to oral implantology. Due to improvements in biomaterials and clinical procedures, implant therapy is currently predictable, with an 89.5 to 99.2% survival rate of functional rehabilitation.1-6
Despite high survival rates given in the literature, the scientific community seems heavily affected by the escalating discussion on peri-implantitis. This has divided the scientific community and risks to ruin the good reputation of implant dentistry. Some of these disagreements are related to the inconsistency in the case definition, case selection, and the variability in diagnostic thresholds for disease.7-9 Two recent systematic reviews indicated that homogeneity in peri-implantitis reporting is still lacking.10,11 One of the systematic reviews listed nine different threshold levels for radiographic bone loss applied to diagnose peri-implantitis and the other review detected ten case definitions for peri-implantitis.
In addition, the focus of clinical research has shifted from predominately survival- oriented to patient-centred outcomes and peri-implant health. The latter is paramount for long-term success. A prerequisite for peri-implant health is peri- implant bone stability. Stable peri-implant bone levels preserves soft tissue, prevents recession and possible esthetic burdens, and minimizes the risk for complications such as ‘peri-implantitis’, implant fractures, and eventually implant loss.12,13 The peri-implant bone level could be affected by patient-, implant-, and site-specific factors. In the paragraphs below we will outline how these factors influence implant success and what the remaining gaps in the literature are.
■ PATIENT-RELATEDFACTORS
Besides the issues mentioned above, patient-related factors such as the inability to perform oral hygiene are related to peri-implantitis14 and regular maintenance is key for the prevention of this disease.15 These findings are confirmed by a meta-analysis including 13 papers. The authors concluded that a more regular, individually tailored peri-implant maintenance therapy prevents possible biologic complications over time and improves the long-term outcome of implants.16 Recent systematic reviews investigated the relationship between additional patient-related factors and the implant treatment outcome. Amongst these factors, smoking habits have
GENERAL INTRODUCTION
11
1