Prevention is the best treatment – Part 2
PD Dr. Kristina Bertl, PhD MSc MBA
The importance of preventing peri-implant diseases is something we have already highlighted in a previous report („Prevention is the best treatment!''), which focused on the findings from the 18th European Workshop on Periodontology. Given that treating peri-implant diseases still poses a huge challenge, it makes sense to revisit the topic of prevention based on a new review (Sun et al. 2023) and to examine it from different angles. After all, as we established in our first report, prevention should be a top priority.
Prevention involves both identifying risk factors and taking measures to avoid and/or minimise them. The risk factors associated with peri-implant diseases (peri-implant mucositis, peri-implantitis) can generally be divided into three categories:
- Patient-specific risk factors
- Implant-specific risk factors
- Long-term risk factors
Patient-specific risk factors for developing peri-implant diseases include first and foremost a history of periodontitis and smoking, with diabetes close behind. However, there are still a lot of question marks over genetic risk factors in this area.
Implant-specific risk factors are mainly associated with surgery and implant prosthetics. Factors such as implant positioning, the structure of the hard and soft tissue and the prosthetic components used have a role to play in this, as does the shape of the prosthetic restoration.
In terms of long-term risk factors, there are two that stand out in particular: 1) oral hygiene habits (plaque control) and 2) supportive implant therapy. These well-known factors are probably two of the most significant ones when it comes to risk. Given that the aetiology of peri-implant diseases is based on biofilm accumulation and dysbiosis, it is quite clear that teaching patients the right way to maintain good oral hygiene at home must be a top priority. However, we also know that susceptibility to peri-implant diseases varies, so a certain level of plaque will not necessarily trigger these conditions in every patient. This is why supportive implant therapy is vital too. If patients regularly stick to the recommended regime, supportive implant therapy can make it possible to diagnose and treat peri-implant diseases at an early stage and, hopefully, prevent them from progressing further. It is also worth remembering that you can keep an eye out for patient- and implant-specific risk factors during supportive implant therapy too, so you can respond to them and – ideally – minimise them.
- Sun TC, Chen C-J, Gallucci GO. Prevention and management of peri-implant disease. Clin Implant Dent Relat Res. 2023;25(4):752‐766. doi:10.1111/cid. 13206