Page 28 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

CHAPTER 3
prevention.22,23 This is confirmed by a meta‐analysis including 13 papers concluding that a more regular, individually tailored peri‐implant maintenance therapy prevents possible biologic complications over time and improves the long‐term outcome of implants.24 Recent systematic reviews scrutinized additional patient‐ related factors and their association with implant treatment outcome. Among them, smoking habits have been shown to affect implant failure irrespective of implant surface, increase the risk of postoperative infection, and yield more marginal bone loss especially in the maxilla.25 The history of periodontal disease was suggested as a second important patient‐related factor. An increased susceptibility for periodontitis may translate into an increased susceptibility for implant loss, loss of supporting bone, and/or postoperative infection.26 No significant relation could be identified between diabetes and implant failure as no differences were observed between patients with and without diabetes.27 As concluded in multiple articles, the difference in occlusal loading between immediate non‐functional and immediate functional loading may not affect the survival of these implants and no significant effect on the marginal bone loss has been reported.28 Furthermore, peri‐implant mucositis can also be induced by residual cement in the sulcus or be related to implant/prosthetic factors and lead to peri‐implantitis.29,30 In a systematic review including 79 papers, it was suggested that the implant factor surface roughness had an impact on peri‐implant bone loss.1 The bone loss around the moderately rough and minimally rough surface implants was less than around rough surface implants. The additional meta‐analysis confirmed that a history of periodontal disease and smoking leads to more peri‐implant bone loss.
Definition of peri‐implant disease
Peri‐implant mucositis is defined by the 6th European Workshop of Periodontology as a reversible inflammation of the peri‐implant soft tissue with no signs of loss of the supporting bone. In the 7th European Workshop, it was diagnosed as bleeding on gentle probing.31 Peri‐implantitis is defined as inflammation of the soft tissues in combination with ongoing loss of the supporting peri‐implant bone beyond the physiological bone adaptation.32 The latter takes place as a consequence of biologic width establishment during initial healing. In the 3rd EAO consensus conference, it was stated that this initial bone remodeling may be unrelated to infection and is not necessarily peri‐implantitis.33 It was therefore suggested that monitoring of implant performance should not be based on radiographs taken
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