Page 27 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

HOW DO PERI-IMPLANT BIOLOGIC PARAMETERS CORRESPOND WITH IMPLANT SURVIVAL AND PERI-IMPLANTITIS? A CRITICAL REVIEW
■ INTRODUCTION
Dental implants are widely used to restore partial and full edentulism. Due to a continuous improvement of implant designs, implant surface topographies, and prosthetic components, implant dentistry today yields excellent long‐term results in terms of implant survival. Doornewaard and colleagues performed a systematic review including papers with above 5‐year follow‐up yielding a 97.3% weighted implant survival rate.1 Numerous clinical studies with a 10‐year follow‐ up yield survival rates of over 95%.2-6 For single tooth replacements on turned implants, cumulative survival rates of 96.8% after 17–19 years and 91.5% after 16–22 years were reported.7,8 In fully edentulous jaws, a 97% implant survival after on average 14 years has been reported.9 Up to 20 years, implant survival rates in the range of 80%–95% have been reported with turned implants in fully edentulous jaws.10-13 Chappuis and colleagues reported in a prospective study 89.5% survival of titanium plasma‐sprayed implants after 20 years of function in partially edentulous cases.14 Compared with the era of introduction of dental implants in clinical practice half a century ago, implant survival is today predictable, regardless of implant length, implant diameter, bone quality, available bone volume, surgical, or prosthetic treatment protocol.15 Apart from restoring function and esthetics, this has also affected patient‐reported quality of life.16
This positivity has over the last decade been affected by the escalating discussion on peri‐implantitis, which 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.17-19 Two recent systematic reviews indicated that homogeneity in peri‐implantitis reporting is still lacking. Tomasi and Derks listed nine different threshold levels for radiographic bone loss applied to diagnose peri‐implantitis, and Ramanauskaite and Juodzbalys detected 10 case definitions for peri‐implantitis.20,21 It is doubtful whether this is beneficial for the patient in the long run given the clinical treatment consequences that may follow, which could lead to unnecessary surgical treatment or even implant removal.
It is evident that patient‐related factors such as the inability to perform oral hygiene are related to peri‐implantitis and that regular maintenance is key for
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