What is best practice for managing peri-implant diseases?

21 May 2024

Peri-implant diseases are inflammatory conditions that affect the peri-implant tissues. They encompass two distinct conditions: peri-implant mucositis and peri-implantitis. The former is an inflammatory lesion of the peri-implant mucosa, without bone loss. It is characterised by bleeding on gentle probing, as well as redness, inflammation, and increased probing depth. Peri-implant mucositis is a reversible condition caused by a microbial disruption at the implant-mucosa interface. It can be caused and progressed due to biofilm accumulation, smoking, and radiation therapy.[i]

The latter, peri-implantitis, is a biofilm-associated pathological condition which occurs in the tissues surrounding dental implants. It is characterised by inflammation and the progressive loss of supporting bone. Signs include inflammation, bleeding on probing, increased probing depth, mucosal recession, and radiographic bone loss. Peri-implant plaque biofilm is the primary cause of peri-implantitis, with other risk factors including: a history of severe periodontitis, poor plaque control, and irregular supportive peri-implant care after treatment.ⁱ

Peri-implant diseases are a growing public health concern, with a high prevalence and potentially devastating consequences (implant loss).ⁱ As such, it is vital that clinicians have a good understanding of preventing and managing both peri-implant mucositis and peri-implantitis.

Guidelines for best practice

The BSP Implementation of Prevention and Treatment of Peri-implant Diseases – The EFP S3 Level Clinical Practice Guideline offers recommendations for the prevention and treatment of peri-implant diseases, facilitating a consistent, interdisciplinary, evidence-based approach.ⁱ

Peri-implant mucositis is treatable, and can be successfully managed by carefully controlling of the peri-implant biofilm. If it is allowed to persist, however, peri-implantitis will develops. It is believed that peri‐implant mucositis always precedes peri‐implantitis, which results in larger lesions. Peri-implantitis, without treatment, can accelerate very quickly – much faster than is commonly seen in periodontitis.ⁱ

The Prevention and Treatment of Peri-implant Diseases Guideline identifies best-practice interventions for preserving the health of peri-implant tissues, and therefore extending the survival of dental implants, and minimising complications. It encompasses 55 clinical recommendations for the prevention of peri-implant diseases, which are directly relevant to the UK healthcare community including the public.ⁱ

 

Recommendations for improved outcomes

The Guidelineⁱ acknowledges that any patient receiving dental implants is automatically at risk for peri-implant diseases because, once the implant is exposed to the oral microbiome it is vulnerable to biofilm accumulation without sufficient intervention. Therefore, during the treatment planning stage, known risk factors, such as smoking, diabetes, and periodontitis, should be addressed, to help lower the risk of complications.

Post-operatively and once the prosthesis has been placed, patients should immediately be subject to a supportive peri-implant care programme in which they are provided with professional plaque biofilm removal, oral hygiene advice and motivation, and early detection of pathological conditions. Patients should be monitored for healthy peri-implant tissues, peri-implant mucositis, and peri-implantitis, and provided with a prompt diagnosis so that appropriate treatments can commence.ⁱ

Once diagnosed as peri-implantitis, clinicians must first decide whether the affected site is treatable. In the case that it is, non-surgical sub-marginal instrumentation therapy should be performed, followed by a re-assessment of the clinical situation. At this point, clinicians should decide between preventative therapy, or surgical treatment – elevating a surgical flap and performing sub-marginal instrumentation. Following successful treatment, patients should be re-enrolled for preventative therapies.ⁱ

Constant monitoring of peri-implant health is critical as it enables clinicians to select the best care pathway for each patient. Effective peri-implant treatment requires the successful, long-term maintenance of the tissues – encompassing behaviour, health monitoring, prevention, and careful treatment decision making.

 

Decision making using appropriate guidelines

As peri-implant diseases have become so widespread, it is absolutely vital that clinicians understand how to prevent, identify, and treat peri-implant issues should they arrive. This means that clinicians must offer patients appropriate advice prior to and following dental implant placement, stay vigilant when patients experience inflammation at the implant site, and decide on the best course of treatment to protect the longevity of the dental implant.

The Prevention and Treatment of Peri-implant Diseases Guideline was created in collaboration with the Association of Dental Implantology (ADI), with ADI representatives including Amit Patel, Pynadath George, Paul Shenfine, Daniel Benson, Sunkanmi Oladeji Olaore, Jaimini Vadgama, Kasia Gurzwaska-Comis, Jiten Vaghela, Viraj Patel, Rajiv Sheth, and Nikos Donos. The ADI is passionate about educating both its members and their patients on how to maintain healthy dental implants, and guidelines which reflect best practice for managing peri-implant diseases mirror this passion.

As dental implant providers, we have a duty to remain educated about best practices in the field. The Prevention and Treatment of Peri-implant Diseases Guideline makes this clear, and offers sound advice to clinicians to help them offer their patients the best possible outcomes.

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