Introduction
The health of the soft tissue around a dental implant called peri-implant health is always a balance or interdependence between the resident oral microbiome or microflora and the host immune system. Any local or systemic factors that cause an alteration in these microbiomes by triggering the release of the inflammatory response through mediators can cause peri-implant disease.
What Is Osteointegration?
Osseointegration is when a dental implant fuses with the bone and stays firmly in place. Its success depends on the overall health. In simple terms, it is like having a strong and stable connection between the implant and the bone. This connection is affected by the materials used, how they interact with the bacteria in the mouth, and the bone's natural changes.
If one has problems with the tissue around the implant, like inflammation, it can cause swelling and make the implant less stable. This can lead to problems in the long run and make the implant more likely to fail. Besides the bacteria in the mouth, other things like race and gender can also affect how well the implant works, depending on the overall health.
What Factors Can Affect the Osseointegration of a Dental Implant?
The following are the risk factors that can affect the osteointegration of a dental implant:
Local Risk Factors:
-
Periodontal Disease Risk Factor for Implant Failure: Though this is a localized disease of the gingiva and alveolar bone, it nearly affects 63 percent of the global adult population as per research, and severe forms of periodontitis (inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth) are always associated with a systemic health condition or cause. The underlying cause of periodontal disease may be purely local gingivitis progressing to periodontitis or also due to certain health conditions and systemic disorders (diabetes, hypertension, endocrine disorders, dyscrasias, immunocompromised patients, patients on drug therapies, and nutritional diseases) that cause a dysbiotic (imbalance in bacterial composition) oral microbiome. As per current implant dentistry research, 50 percent of patients suffering from periodontitis may be attributed to genetic risk factors and poor oral hygiene status making these individuals even more risk prone to prosthetic implant failures. Hence, It is always suggested that the dental or oral surgeon treat the cause and effect of periodontal disease in patients before dental implantation or there is a higher risk of biologic failure due to failure in osseointegration. This is also attributed to the periodontal hypothesis that the bacterial translocation may occur from the periodontal pocket to the peri-implant tissue sulcus creating a microenvironment with specific pathogenic populations causing subsequent implant failure.
-
Poor Oral Hygiene: According to most cross-sectional and retrospective study research, poor oral hygiene and compliance have in fact emerged as the biggest factor that can cause plaque deposition, microbial colonization, subsequently peri-implant bone loss, and inflammation resulting in a failure in the implant stability in the long term. Poor oral hygiene is also implicated risk factor for overall marginal bone loss and hence professional and personal plaque control measures by the dentist and the individual play a major role in averting the failure of dental implants.
-
Smoking: Nicotine is not only a potent inhibitor of new bone or osteoblast cell formation but also in smokeless or smokable forms of tobacco that contain nitrosamines. There is a chronic and eventual decline in bone mineral density (BMD) as per case reports and also reduced calcium absorption, all these pathogenesis can contribute to dental implant failure in smokers.
Systemic Risk Factors:
-
Systemic Health Diseases: The American Society of Anesthesiologists has classified certain health conditions to be risk factors for implant failure as a result of chronic systemic disease that would affect the dental implant and its prosthesis, these are:
-
HIV (human immunodeficiency virus) infections.
-
OLP or oral lichen planus.
-
Sjogren syndrome (an autoimmune disorder that reduces the amount of moisture produced by glands in the eyes and mouth).
-
Ectodermal dysplasia (a genetic disorder affecting the development or function of the teeth, hair, nails, and sweat glands).
-
Organ transplant patients.
-
Immunocompromised patients.
-
Cardiovascular diseases.
-
Diabetes patients with poor glycemic control.
-
Crohn's disease (inflammatory bowel disease causes chronic inflammation of the GI tract, which extends from the stomach all the way down to the anus).
-
Neuropsychiatric disorders for example Parkinson's syndrome and epilepsy.
-
Scleroderma.
-
-
Patients on Systemic Drug Therapy or Medications: In the long-term treatment of many chronic conditions like cancer, HIV, autoimmune diseases, chronic inflammation, depression, and rheumatoid arthritis, there is a higher chance of dental implant failure due to the medications used. For instance, approximately 12.1 percent of people in the United States of America (USA) frequently use NSAID drugs (non-steroidal anti-inflammatory drugs), which can hinder a specific pathway related to bone-implant contact, potentially leading to reduced bone support for dental implants. Similarly, the use of glucocorticoids or long-term bisphosphonates can contribute to bone resorption over time, affecting the natural bone remodeling process. This can reduce the formation of new bone and impact the quality of bone around dental implants, increasing the risk of implant failure. Even medications like selective serotonin inhibitors, used to treat depression, can stimulate bone resorption, further raising the risk of dental implant failure by affecting the balance of bone-regulating processes.
-
Patients With a History of Chemotherapy and Radiotherapy: Chemotherapy can often lead to a condition called oral mucositis, which affects the soft tissues in the mouth and can harm the long-term success of dental implants. Additionally, when bone is exposed to radiation, it can reduce the bone's ability to repair itself and decrease the blood flow in the bone. This can result in lower survival rates for dental implants, as recent research in implant dentistry has indicated.
Conclusion
To conclude, these risk factors are of multi-varied origin and though the peri-implant disease is mainly responsible for the eventual dental implant failure that may occur (maybe a slow progression) it is important that the implantologist eliminates these risk factors. The elimination of the local and systemic risk factors that affect the implant tissue health and in contrast, the oral healthy microbiome plays a crucial role in the management of long-term dental implant success by the implantologist or the oral surgeon.
