The reason dental implants are considered a good standard prosthesis is because of their permanent integration or fusion into the alveolar bone and either by cement retained or screw-retained crowns they can be adjusted to the patient's occlusion restoring the masticatory forces as close as possible to the natural efficiency and chewing forces associated with natural teeth when compared to the crown, bridge or removable dental prosthesis that has limited efficiency and capacity or support. But dental implant success is not only dependent upon various factors like the patient's age, their systemic condition, the local conditions of the oral cavity in the patient, and the bone density or the width available that all need to be planned preoperatively by the dental implantologist prior to implantation. It is also dependent long term for its success only upon not developing any form of implant-related diseases like peri-implant disease ie peri-implant mucositis and periimplantitis.
What Is the Focus of the Implant Dentist for Long-Term Implant Survival?
The most common risk factor, of course, is considered to be periodontal disease or periodontitis which is a locally aggravating factor that may contribute to dental implant failure in the long term affecting the five to seven-year survival rates. Research in implant dentistry hence focuses upon the various surgical and non-surgical strategies available to the implant dentist to rectify the issues cropping up due to the development of peri-implant diseases and the key to prevent them is always said to be by primary prevention of bacterial film accumulation or biofilm accumulation. The accumulation of the biofilm is considered mainly to be the primary etiologic factor in invoking host Inflammatory mediators or inflammatory reactions causing peri-implant disease and in turn affecting the primary stability of the dental implant predisposing it to failure by anchorage or unstable fixture in the alveolar bone.
How to Diagnose Peri-Implant Disease?
The diagnosis of peri-implant mucositis is characterized by clinical features observed by the dentist.
Bleeding or suppuration upon gentle probing: This is observed either with or without increased probing depth in comparison to the previous examinations.
There is no observable bone loss beyond crestal bone level that may have resulted from initial bone remodeling.
If the diagnosis of this disease is established, the inflammation should be resolved hence primarily by adopting non-surgical treatment strategies. In advanced cases of peri-implant diseases be it mucositis or implantitis. However, surgical therapies like augmentative and non augmentative approaches that include resective or flap debridement procedures will also not be sometimes efficacious in such disease progressions. Hence prevention or non-surgical management initially remains the key to stopping further advances in peri-implant disease.
Is Peri-Implant Disease Reversible?
According to implant literature and documentation, just as in the example wherein the periodontal disease or bone disease follows the gingival disease. Similarly, peri-implant diseases follow peri-implant mucositis which is the primary precursor or disease wherein the mucosal structure around the implant gets inflamed. In this inflammatory state as well though, the marginal bone is still not lost beyond the initial phase of physiologic bone settlement. Hence this disease of peri-implant mucositis that can lead to peri-implant disease or periimplantitis resulting in implant infection, instability, mobility, failure, and exfoliation can be prevented by certain non-surgical strategies that are adopted in timely assessment and management by the implant dentist. The focus of the implant dentist is to resolve the inflammatory reaction that is invoked around the dental implant and when addressed in the initial or developing stages on time and with regular follow-ups to ensure the health of the dental implant post-implantation like six-monthly to 12 monthly intervals, implant disease is not only a reversible condition but also can be altogether prevented by maintaining adequate oral hygiene, chemical or mechanical plaque control forms and dentist support or management in clinic.
What Are the Non-surgical Modalities?
Let us take a look into the various non-surgical modalities to prevent implant diseases that will be considered by your dental surgeon in preventing dental implant failure and managing or restoring the implant to successful form and function.
Non-surgical Mechanical Therapy or Debridement: Either by the usage of mechanical instruments like curettes alone, curettes plus ultrasonic device or only through ultrasonic devices, the implant dentist will aim to reduce the probing pocket depth (PPD), Plaque index (PI), Bleeding on Probing (BOP) parameters.
Chlorhexidine Adjuvant Therapy: Many randomized controlled trials have reported the efficacy of applicator chlorhexidine gel 0.2 % or chlorhexidine mouthwash as adjuvant therapy to non-surgical mechanical debridement that can improve or lessen the symptoms of clinical inflammation around the implant tissue.
Probiotic Therapy: The implant dentist can recommend conventional mechanical prophylaxis with probiotic therapy like with probiotic Lactobacillus reuteri that would have a potent antimicrobial effect along with a significant reduction in the bleeding on probing (BOP) sites at 6-week intervals after this therapy. ￼
GPAP or Glycine Powder Air-Polishing: When GPAP is used alongside non-surgical debridement of inflamed tissues like with cigarettes and ultrasonic devices as mentioned earlier it would aid in reducing the viable bacterial count and in aiding the removal of Biofilm. ￼
Antimicrobial Therapy: The supplemented use of antibiotics post non-surgical therapy or debridement such as locally delivered tetracycline into the peri-implant tissue or short-term use of the systemic antibiotic Azithromycin can be considered by some implant dentists to maintain the health of the soft tissue around the implant.
To conclude, though the focus of the dentist through the initial phases of peri-implant disease diagnosis remains the non-surgical strategies elaborated, for complete resolution and health of soft tissue around the dental implant ie the peri-implant health - Regular dental follow-ups post-implantation, proper oral hygiene, and antimicrobial prophylaxis plays an important role in shaping long term survival outcomes of implants. Also in advanced cases of Periimplant disease, surgical therapies may be indicated by your implant dentist.