Peri-implant diseases: “Are we ready to take the epidemic in the offing – Head on”

Currently, when one talks about the safest and patient-friendly alternatives for the replacement of the missing teeth, probably, the only viable alternative that strikes the minds of the clinicians is Dental Implants. Treatment with dental implants has shown a high degree of predictability, with a survival rate to the tune of 90-95%, for more than 5 years.[1]

The overall global market for dental implants, as guessed in the year 2021 has been close to U.S.D. 4.12 billion, with over 9 million implants placed.[2] According to an estimate, there were more than 100 commercial brands of implants available in the year 2021.[3] As per the American Academy of Implant Dentistry, 3 million people in the United States have implants, a number that is growing by 500,000 annually.[4] The annual implant market in Europe has been estimated to be that of 5.5-6 million implants.[3]

However, as the number of patients who have dental implants is increasing, the chances of dental professionals getting to see cases of Peri-implant diseases (PIDs) are also increasing. Like teeth, dental implants can be affected by diseases in a manner similar to the teeth and fail after months or years in service due to technical or biological complications. Implant failures due to complications can have immense financial implications and can affect the perception of the patients toward dental implants. The most relevant biological complications related to dental implants are the Peri-implant diseases. Usually of microbial origin, the Peri-implant diseases have been described under two categories i.e. Peri-implant mucositis (PM) & Peri-implantitis (PI).[5]

There are variations related to the prevalence rate of Peri-implant mucositis and Peri-implantitis, across the globe. Derks et al. have reported the prevalence rate of Peri-implant mucositis to be 19%- 65%, while that of Peri-implantitis is in the range of 1% - 47%.[6] Lee et al. in their meta-analysis showed that the mean prevalence of Peri-implant mucositis was 29.48% (implant based) and 46.83% (subject based), and the mean prevalence rate of Peri-implantitis was 9.25% (implant based) and 19.83% (subject based).[7] As per Rakic et al.’s meta-analysis, the prevalence rate of Peri-implantitis was 18.5% (Implant level) and 12.8% (patient level).[8]

An extensive perusal of the literature related to the epidemiological aspects of Peri-implant diseases reveals that, though the literature is replete with data from Western countries, the situation in India is not very clear, courtesy the pending, authentic data from quality studies. With this comes the urgent need to assess the peri-implant disease load in the Indian population through some well-planned nationwide studies. I am pretty sure that the Indian Society of Periodontology (I.S.P.) as a responsible professional organization must be keeping a close watch on this.

The variations in the prevalence rates of peri-implant diseases, both globally and in India (from whatever sporadic data we so far have) are probably due to heterogeneity in the methodology used for reporting the peri-implant diseases. These variations are a big deterrent to the attempts being made to truly estimate the global/Indian load of Peri-implant diseases, emphasizing the urgent need to adopt the case definitions of Peri-implant diseases that are globally acceptable and with minimal shortcomings.

To overcome this hurdle and some of the perceived shortcomings of the available case definitions, I.S.P. is working on a document to describe the Peri-implant diseases in words that shall try to minimize the ambiguity related to the case definitions of Peri-implant diseases.

With the global share of dental implants being placed by the Indian dentists soaring with each passing day, it is expected that the peri-implant diseases will pose a significant future challenge to the oral health care providers in India. The big question is “Are we ready as the responsible clinicians/academicians of the country to take this epidemic in the offing, head on.” Probably, this needs concerted & collaborative efforts from the professional societies of the country in particular & clinicians in general. There is an urgent need to craft strategies to mitigate the impact of peri-implant diseases on the oral health from an Indian perspective. I personally feel that the proposed classification and case definitions of Peri-implant diseases by the I.S.P. are a step in the right direction.

We as Periodontists must take the lead, first of all, to contribute towards the genuine and precise data related to the load of peri-implant diseases in the Indian population and then to devise various effective ways to tackle this disease load. If we want to ensure that dental implant therapy continues to enrich the lives of countless Indians and the population elsewhere, this is probably the need of the hour.