In my last editorial I had mentioned regarding the impending surge in the cases of peri implant diseases and had questioned regarding our preparedness to deal with this in the Indian Scenario. In view of the high prevalence rates of peri implant diseases (PID’s), it is imperative that a number of patients rehabilitated with dental implants sooner or later may experience these biological complications, i.e. PID’s.
The main cause for the biological complications is dental plaque,[1] though factors like history of Periodontitis, suboptimal plaque control and the absence of regular supportive peri implant care (SPIC) may enhance the risk for peri implant diseases.
Our knowledge regarding the differences in the structures that supports a natural tooth and that of a dental implant reveals that, when confronted with accumulation of dental plaque, the dental implants are comparatively more susceptible to the inflammatory processes and the breakdown of the supporting structures.
With the refinement in our knowledge regarding the factors responsible for PID’s, there appears to be a shift in the concepts related to the long term success of the dental implants. For the overall, long-term success of the implants, the focus seems to be shifting from the role of surgical phase of implant therapy to the long-term maintenance of the health of the peri implant tissues.[2] Ergo, for the successful and long-term maintenance of dental implants a regular and well established maintenance protocol must be in place and begin during the dental implant planning itself.
The major focus of the maintenance protocol of the dental implants should be on the prevention of peri implant diseases and promotion of periimplant tissue health.
According to recent European Federation of Periodontology (EFP) S3 level clinical practice guidelines on the prevention and treatment of PID’s, the prevention should begin at the time of dental implant planning and continue at the surgical stage and prosthetic loading i.e. Primordial Prevention.[3] The primordial prevention should always be followed by different modalities for the primary prevention of PID’s. In cases of early and advanced periimplant diseases various preventive means to extend the longevity of implants can be adopted at secondary and tertiary levels.[4]
In regard to the long term maintenance of the dental implants in the mouth there is an urgent need to dispel at the initial stage itself the prevalent notion among the patients that the dental implants, like natural teeth does not require much of care. There comes the need to effectively convey to the implant seeking patients, the importance of home care and SPIC.
A prominent role should be given to the implant patients education regarding the initial symptoms of PID’s. According to a study by Brunello et al. (2020) only 32% of patients receiving dental implants reported that they were educated regarding the management of bleeding around dental implants.[5]
Costa et al. investigated the relationship between the preventive maintenance and occurrence of the biological complications of dental implants. They reported that the patients suffering from peri implant mucositis, when followed up for the incidence of peri implantitis, with and without preventive maintenance reported higher incidence (43.9%) in patients who did not follow preventive regime than the ones who followed the preventive maintenance (18.0%).[6]
Considering the variations in the skills, manual dexterity, type of implant supported prostheses, presence or absence of periodontal disease, systemic status and other risk factors in a patient having implants, customized maintenance protocols can be devised for different categories of patients.
The tailored follow up programme for each implant patient must include four essential steps in each SPIC appointment:
Monitoring peri implant care tissue health
Assessment of the overall oral hygiene status
Enhancing oral health through education, motivation and risk management
Professional plaque removal
Treating infected sites.
Though the peri implant diseases cannot be avoided completely, in the absence of a predictable treatment regime for peri implantitis, the primordial and primary prevention, especially the early diagnosis of peri implant mucositis and preventing its progression into peri implantitis can go a long way in improving the long term success rate of implants.
REFERENCES
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