Prevention is crucial, at all stages
“Control of risk indicators may limit periimplantitis and eventually implant loss.” Giovanni E. Salvi | Switzerland Associate Professor, Vice Chairman and Graduate Program Director University of Bern, School of Dental Medicine Interview conducted by Marjan Gilani
“Biological complications around implants are a reality we need to face,” says Giovanni Salvi, associate professor in the department of periodontology at the University of Bern. He believes clinicians can prevent implants from reaching the final stage of peri-implantitis, if problems are detected early. Prof. Salvi, explantation is an emotional burden for patients. How often do implants fail? Prof. Salvi: Early implant loss happens in about 1–2 % of cases when the process of osseointegration is disturbed.¹ This may occur because of reasons such as lack of primary stability, infection after placement or unintentional early loading. Late implant failures, on the other hand, may occur because of late diagnosis and lack of treatment of peri-implantitis. Peri-implantitis is an inflammatory disease initiated by bacterial biofilms. It is characterized by the presence of bleed-
ing on probing (BoP) and/ or suppuration, increased probing depths compared to previous examinations and by the presence of bone loss beyond normal crestal bone level changes resulting from initial bone remodeling.² The reported prevalence of peri-implantitis ranges from 1 to 47% (mean 22 %).³ However, the wide range of reported prevalence in the literature reflects the high heterogeneity of clinical and radiographic thresholds adopted for disease definition, which makes a precise estimate of the prevalence of peri-implantitis difficult.
“When we let an implant reach the final stage of periimplantitis, no one can perform a miracle to save it.”
What is the key to peri-implantitis control? Several risk indicators have been identified that may lead to the establishment and progression of peri-implantitis. Hence, control of such risk indicators may limit peri-implantitis and eventually implant loss. These risks may include poor self-performed plaque control⁴, tobacco consumption⁵, history of treated periodontitis⁶, restorations with inadequate access for plaque control⁷, presence of excess cement⁸, lack of compliance with regular supportive care⁹–¹⁰ and lack of treatment of peri-implant mucositis¹¹.
Can all implants be saved following peri-implantitis therapy? Unfortunately, not all implants can be saved in the long-term following therapy for peri-implantitis. For example, 5-years following surgical therapy of peri-implantitis with open flap debridement, adjunctive systemic antimicrobials and regular supportive care, implant loss was still observed in 17% of cases.¹²
How do you proceed when explantation is the only option? Implants having completely lost osseointegration are mobile and can be explanted without having to raise a mucoperiosteal flap. Hence, from a diagnostic
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