Peri-Implantitis Treatment and Complications

 

How do we treat peri-implantitis?

In order to stop disease progression, prevent further bone loss, and restore the affected implant (where possible), non-surgical and surgical treatment approaches may be employed. Non-surgical methods include mechanical debridement, application of antimicrobials (such as chlorhexidine or antibiotics), and the improvement of oral hygiene. This should be followed by controlling risk factors, such as smoking, and diabetes. In more advanced cases, where there is significant bone loss, surgical treatment may be needed, including access flap surgery, bone grafting to restore bone volume, and laser treatment for decontamination.[i]

 

How successful is the treatment of peri-implantitis long-term?

Research suggests that, when protocols include individualised supportive care, treatment of peri-implantitis results in high survival of implants after five years, with approximately 75% of implants still present after this time.[iii] This conclusion is supported by a systematic review which found that implant survival was 81.73%–100% at 3 years, 74.09%–100% at 4 years, 76.03%–100% at 5 years, and 69.63%–98.72% at 7 years.[iv

 

Technical Complications

Do loading protocols affect mechanical and technical complications?

Loading protocols may have a negative impact on success if specific criteria are not met or if the clinical procedure is not executed to a sufficient standard.

 

Does abutment material selection influence mechanical and technical complications?

Implant abutment material may influence the occurrence of mechanical and technical complications. Often, titanium is a versatile and reliable option for mechanical outcomes, but zirconia offers optimal aesthetics. Therefore, clinicians must consider the functional and aesthetic factors in every case.[v]

 

Does crown to implant ratio influence mechanical and technical complications?

A high crown to implant ratio may lead to complications due to unfavourable occlusal forces on the bone surrounding the neck of the implant, as well as within the connection of the crown and the implant.[vi]

 

Does implant angulation influence mechanical and technical complications?

According to the research, there are no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge compared to implants that are intentionally tilted towards the distal aspect of edentulous jaws.[vii] However, there is some evidence that tilting an implant can impact implant stability and the surrounding bone.[viii

 

Does implant design affect mechanical complications?

Research identified only clinically insignificant differences between tapered and non-tapered implants in terms of clinical outcomes.[ix]

 

Does the implant-abutment connection influence mechanical and technical complications?

Both metal and ceramic abutments with internal and external connections exhibited high survival rates. Further to this, implant-supported prostheses with internal and external connections also had high survival rates.[v]

 

Does impression technique influence mechanical and technical complications?

Research suggests that optical scanners, in combination with OCT, may be effective in accurately assessing misfits between reconstructions and dental implants.[xi] This is further supported by research that suggests intraoral optical impressions are more time efficient than conventional impressions. However, the same report stated that there may be many factors at play, and no clinical recommendation can be made at present.[xii]

 

Does superstructure material selection influence mechanical and technical complications?

Research suggests that zirconia-ceramic implant-supported single crowns are a valid alternative to metal-ceramic, as they have a similar incidence of biological complications without the aesthetic problems.[xiii] Another report assessing the five-year survival of different systems found that all-ceramic and zirconia performed the best, with the lowest rates in resin-based hybrid ceramics. This was because resin-based hybrid ceramic crowns are more prone to fracture, exhibiting more fractures than veneered alumina and zirconia.[xii]

 

Does the choice between screw and cement retention influence mechanical and technical complications?

Research suggests that the mode of retention, whether cemented or screw-retained, does not influence survival rates of abutments or reconstructions. However, screw loosening is a potential risk factor in screw-retained reconstructions.[xii]

 

How common are mechanical problems?

Mechanical problems appear to be relatively rare, according to the research, with survival rates of full arch screw-retained prostheses between 92% and 100% over 1-10 years.[xvi]

How common are technical complications?

According to the research, technical complications are rare, with no technical complications observed in about 86.7% of metal-ceramic single crowns.[xiii]

 

What is the definition of technical complications?

Technical complications with dental implants can include a number of things, such as screw loosening, loss of retention, and fractures. [xiii]

 

What is the influence of cantilevers on mechanical and technical complications?

Implant-retained restorations with cantilevers show high survival rates both in fully and partially edentulous jaws. This makes them a viable treatment option in both of these scenarios.[viii]

 

What is the influence of implant diameter on technical and mechanical complications?

Research has found that narrow diameter implants of at least 2.5 mm demonstrate no difference in implant survival rates when compared to standard diameter implants. However, those with a diameter of less than 2.5 mm had lower survival rates compared to the standard size. This is because reducing the implant diameter can result in an increased risk of implant or component fracture.[xx]

What is the influence of implant length on technical and mechanical complications?

The selection of implant length must depend on the specifics of each case and patient. However, when there is sufficient bone height, implants longer than 6 mm are preferred. [xx] This is because implants which are less that 6 mm in length present a greater risk of failure.[xxii

 

What is the influence of splinting narrow implants on technical and mechanical complications?

Due to the reduced implant strength and bone contact afforded by narrow implants, the use of splinted restorations may be advisable [xx] to distribute chewing forces more evenly.

 

What is the influence of splinting short implants on technical and mechanical complications?

Research suggests that the clinical recommendation is to splint restorations where adjacent short implants are involved. [xx]This aims to distribute occlusal forces more evenly across multiple crowns.