Page 69 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

LONG-TERM EFFECT OF SURFACE ROUGHNESS AND PATIENTS' FACTORS ON CRESTAL BONE LOSS AT DENTAL IMPLANTS. A SYSTEMATIC REVIEW AND META-ANALYSIS
■ INTRODUCTION
Today, achievement of osseointegration is no longer the only key issue in research related to oral implantology as the predictability of implant therapy is high due to improvements of biomaterials and clinical procedures. Multiple long-term studies show successful treatment outcomes in terms of functional rehabilitations with survival rates ranging from 89.5 to 99.2%.1–6 Instead, the focus has shifted to peri-implant bone stability, which is paramount for long-term success. Bone loss may lead to complications such as soft tissue recession, “peri-implantitis,” implant fractures, and eventually loss of the implant.
Although dental implants have demonstrated favourable long-term results,7–12 failures do occur and can be related to different factors. For instance, early implant failures have been related to excessive surgical trauma, an impaired healing ability, premature loading, and infection. In addition, late failures are mostly attributed to occlusal overload and/or progressive peri-implant bone loss.13 Most patients of today have lost one or a few teeth and have high demands on the esthetic outcome. Peri- implant bone stability is a prerequisite for soft tissue preservation and hence, bone loss may lead to soft tissue recession and a poor esthetic outcome.14,15
Likewise periodontitis, peri-implantitis is a multi- factorial disease but associated with pathogens colonizing the subgingival biofilm, and the host response.16 Peri-implant mucositis has been described as a reversible inflammation of the peri-implant soft tissues without signs of loss of the supporting bone. 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.17 The reasons for the inflammation is multifactorial and under debate and especially diagnostic thresholds or diagnostic methods in general, are currently leading to biased reports on peri-implantitis prevalences. Some authors look on “peri-implantitis” as a biofilm induced disease while others regard this as an imbalanced foreign body response. However, not every single implant presenting peri-implant bone loss can be defined as peri-implantitis. It is well documented that the initial bone loss is an inevitable reaction to surgery and loading and known clinically as the establishment of a soft tissue seal called “biologic width.”18–20
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