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A pragmatic approach to manage
peri-implant biological complications

Explore the complexities of dental implant care: This scientifically backed article summarises the critical aspects of diagnosis, oral hygiene, and expert strategies for the effective management of both, mucositis and peri-implantitis.

Periodontal treatment improves more than just the periodontium in diabetics

A non-surgical periodontal treatment can reduce the long-term blood glucose level (HbA1c) in type 2 diabetics by 0.3% and this effect persisted even after six months following treatment.

Caution parents – risk of infection!

Untreated periodontal disease in parents can negatively influence the development of their children’s oral microbiome and promote the development of a dysbiotic oral microbiome.

Implant crowns must be kept clean… but how?

The shape of an implant crown has a significant influence on how well it can be kept clean using home oral hygiene, and concave crown shapes appear to be easier to clean; it also seems that the underside of an implant crown in the molar area is easiest to access with dental floss.

Unhealthy lifestyle = worse treatment outcomes?

Factors that can be categorised as a poor lifestyle, and primarily also a combination thereof, significantly increased the number of residual pocket probing depths with ≥ 6 mm and significantly reduced the likelihood of attaining the desired treatment outcome in periodontitis patients following non-surgical periodontal treatment (treatment step 1 and 2).

Successful treatment – does it make a difference? Part 2

Commonly used definitions for successful periodontal treatment are extremely difficult to achieve, but are nevertheless associated with a lower rate of tooth loss; however, the tooth loss rate in patients who regularly attend supportive periodontal treatment sessions is generally very low.

Prevention is the best treatment – Part 2

Biofilm accumulation is the main aetiological factor in the development of peri-implant diseases; plaque control and supportive implant therapy are therefore crucial in preventing peri-implant diseases.

Social participation in society even without teeth?

In old age, tooth loss leads to significantly reduced social participation in society, while maintaining a minimum of 20 teeth has the opposite effect and leads to a significant improvement and therefore more frequent social participation.

Patient- and implant-related factors – what affects the outcome of treatment?

In this study, non-surgical treatment of peri-implantitis was only successful in 25% of cases and was adversely affected by a medical history involving periodontitis and smoking, inadequate oral hygiene and a wide implant diameter.

Keratinised soft tissue crucial for implants

The prevention of peri-implant diseases is the best treatment and the peri-implant soft tissue can play a decisive role here; for this reason, the team should discuss if there is a need for treatment in patients with a lack of keratinised mucosa (i.e. < 2 mm width of keratinised mucosa).

Implants – Also a success story from a patient perspective?

A very high percentage of patients had a positive experience of implant treatment and most patients were very happy with the result; however, frequent points of criticism were the treatment costs and the cleansing ability.

Exercise is great for our health … and our teeth too?

Women who exercise regularly showed a significantly reduced risk of periodontitis and a significantly reduced severity of periodontitis.

No teeth, no quality of life?

Rehabilitation and replacement of missing teeth lead to a significant improvement in quality of life relating to oral health and also tend to improve general health.

Periodontitis also impairs our sense of
taste and smell!

A questionnaire-based survey showed that periodontitis significantly increases the risk of an impaired sense of taste and smell.

Smoking and increased probing depths are early warning signs

Smoking and increased probing depths at a young age (i.e. at an age of < 20 years) are significant risk factors for the early onset of periodontitis (i.e. at an age of < 30 years).

Tooth brushing in just 10 seconds?

Automatic toothbrushing could have future potential, but still requires further technical developments to improve existing shortcomings with regard to customizsation for different jaw sizes and tooth positions, interdental spaces and choice of optimal brushing time.

When as well as possible is not good enough

Even when told to brush their teeth as well as possible, the quality of tooth brushing among young adults is poor; the main weaknesses are cleaning palatal/lingual surfaces and overall brushing technique.

Prevention is the best treatment!

Optimal diabetes control, regular supportive implant therapy and augmentation of peri-implant soft tissue deficits have proven to be crucial features in primary prevention of peri-implant diseases.

Peri-implant mucositis – are chemical adjunctive therapies effective? Part 2!

Additional measures locally applied or taken systemically by the patient (e.g. antiseptics in the form of mouth-rinse solutions or probiotics) could have an additional positive effect in the treatment of peri-implant mucositis.

Non-surgical peri-implantitis treatment – chemical cleaning ...?

Chemical additives for cleaning the implant surface as part of non-surgical peri-implantitis therapy may make sense, but there is a shortage of well-conducted studies with a sufficient number of patients and a long-enough follow-up period to really be able to recommend a specific method and/or a specific product.

Non-surgical peri-implantitis treatment – gold standard ...?

Due to a continuing lack of well-conducted clinical studies, it is still not possible, based on the evidence, to give a clear treatment guideline for mechanical cleaning as part of non-surgical peri-implantitis treatment.

Periodontitis doesn’t normally come alone!

As early as 2016 (Monsarrat et al. 2016), a study outlined a link between periodontitis and 57(!) systemic diseases, the most well-known of these being diabetes mellitus and cardiovascular diseases. Time and again, these links prompt a discussion about the need for positive cooperation between dentists and doctors in order to improve early diagnosis of specific systemic diseases.

Sensitive tooth cervix following periodontal therapy...

Experiencing cervical tooth sensitivity following periodontal therapy? Here’s what you can do about it! Non-surgical periodontal therapy can unfortunately entail a number of disadvantages, which are the sources of some complaints from our patients time and again. For example, they complain about the longer appearance of their teeth and/or about increased sensitivity of the exposed tooth cervix. Studies have shown that around 60 to 90% of our patients suffer from cervical tooth sensitivity in the period immediately following non-surgical periodontal therapy and that from a third up to a quarter of patients still suffer from cervical tooth sensitivity after 4 to 8 weeks (Lin et al. 2012).

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