How to successfully prevent Peri-implantitis

For half a century, titanium dental implants were considered the gold standard when it came to restoring tooth gaps or replacing unsalvageable teeth. However, the initial euphoria surrounding metal dental implants quickly began to fade in the face of mounting cases of long-term complications and calls for more biological, sustainable, and healthier implant materials, such as zirconia. Peri-implantitis, an inflammatory disease affecting the soft and hard tissues around dental implants, has been on the rise for several years, posing major challenges to dental professionals worldwide. 

According to its 2017 clinical guidelines, DG Paro defines peri-implantitis as follows: " Peri-implantitis is a plaque-associated pathological condition that occurs in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation including bleeding on probing and/or suppuration, increased probing depths and/or recession of the mucosal margin, and radiographic bone loss compared to previous examinations [...]" (DG Paro, "EFP New Classification of Periodontal and Periimplant Diseases").

According to recent studies, up to 40% of dental implants are at risk of developing peri-implantitis after five years of wear.[1] Today, titanium implants are primarily associated with an increased risk of peri-implantitis.[2-4] The risk of peri-implantitis also increases with implant systems that do not achieve sufficient soft-tissue adaptation. Pathogenic bacteria can bypass the epithelial barrier around these implants, attach to their surfaces in the form of bacterial biofilm and cause inflammatory reactions. Furthermore, many implant manufacturers rely on screw-retained internal connections that incorporate micro-gaps at their implant-abutment interfaces. Pathogenic bacteria can invade this sensitive area, and cause inflammatory reactions of the surrounding tissues, eventually leading to peri-implantitis.

Studies also indicate that the development of peri-implantitis can be promoted not only by pathogenic bacteria but also by titanium particles. Depending on their roughness, titanium particles can be released from the surfaces of titanium implants under functional load and deposited in the peri-implant tissue.[5] Such titanium particles are then phagocytized by macrophages in the surrounding tissue, which then react – genetically determined – with a release of cytokines, initiating a local inflammatory reaction, which can eventually trigger peri-implantitis. If this serious inflammatory condition remains untreated, the affected dental implant can become unstable owing to the accompanying progressive bone resorption, ultimately leading to implant loss. In addition, oral inflammatory diseases such as peri-implantitis can lead to major general health impairments and the development of chronic diseases. Today, for instance, cardiovascular diseases or even diabetes are often linked to inflammatory diseases in the oral cavity.