Page 202 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

CHAPTER 8
⚪ Baseline registration and further measurement of bone level, probing pocket depth, bleeding on probing and plaque at well-defined time intervals
⚪ An internationally accepted case definition for disease
⚪ The percentage of disease according to the case definition, based on
implant level and patient level
⚪ Proper statistical analysis
3. Clinical studies presented in this thesis need to be prolonged to describe the long-term outcome of implant-related factors, site-specific factors, and early implant surface exposure on crestal bone loss, biologic parameters, and implant survival.
4. For hybrid implant systems, the length of the coronal smooth part needs to be examined.
5. Clinical studies, reflecting the reality of daily practice, are needed to determine whether hybrid-implant systems and macro design modifications are beneficial in patients prone to peri-implantitis.
■ CLINICALRECOMMENDATIONS
The following clinical recommendations based on the results of this thesis and the included literature could be given.
1. Peri-implantitis diagnosis should be made on more than one clinical parameter. Preferably, crestal bone loss or the crestal bone level and bleeding measurement around the implant are used.
2. The baseline radiograph should be made after crestal bone remodeling due to biologic width reestablishment. This results in a timeline of 3 to 6 months after implant surgery in a one-stage procedure and 3 to 6 months after second-stage surgery.
3. Implants should be installed regarding the soft tissue thickness to prevent early surface exposure due to biologic width reestablishment. The advice is to take at least 3 to 4 mm soft tissue thickness into account.
4. When bone level implants are placed, the use of an implant system with a platform shift between the implant and abutment is advised.
5. In risk patients, the use of a hybrid implant system is likely beneficial.
6. Implant treatment, including peri-implant maintenance therapy, should
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