Peri-implantitis and the prosthodontist

Key Points

  • Peri-implantitis is a poorly understood condition which is difficult to manage and better prevented with careful control of all phases of treatment.

  • Many aspects of prosthodontic treatment have an impact on peri-implant heath with far reaching potential consequences.

  • Prosthodontic procedures such as impression taking, temporisation, and cementation may have long term consequences as a result of contamination of the implant surface.

  • The use of low cost generic components, inappropriate materials, and poor decisions made in the laboratory may all impact upon peri-implant health.

Abstract

Peri-implantitis has been described as progressive crestal bone loss around a dental implant. The condition is poorly understood, and is challenging to manage; it is commonly and widely attributed to issues with the implant, the implant surface, surgical technique and oral hygiene. The effect of prosthodontic stages of treatment on the postoperatively established state has not been adequately investigated. It is the authors' contention that the manner in which the implant is restored contributes significantly to prognosis and peri-implant disease experience, and that the role of prosthodontic aspects of treatment in the causation of peri-implantitis may be seriously underestimated. The prosthodontist has a clear role and responsibility in the avoidance of future peri-implant problems by ensuring that implants are restored in an entirely biologically and biomechanically sound manner. The number of implant treatments carried out year-on-year is rising apace, with more and more implants being restored in general dental practice. With the rapid emergence of lower cost dental implant systems and a broadening range of generic restorative options and components for well-established systems, there is an increasing need to consider and understand how the implant restorative process may have a negative impact upon the peri-implant tissues, and how this effect may be minimised and peri-implant health promoted and maintained by paying attention to detail throughout the entire process.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1: (a) Peri-implant mucositis; cleaning is poor and there is gingival inflammation present in association with the natural central incisor tooth and the lateral incisor implant unit.
Figure 2
Figure 3: (a) In this case impression material has extruded into an extraction site and onto the implant surface, motivating the author to remove and replace the contaminated implant.
Figure 4: (a and b) Gold abutment removed from implant.
Figure 5: A patient returned for review having been provided with a screw retained porcelain bonded to milled cobalt chrome implant crown, fitted directly to the implant.
Figure 6: CAD CAM design of a zirconia abutment onto which porcelain will be directly bonded.
Figure 7
Figure 8: This porcelain bonded to metal crown (a) has been perforated so that it can be permanently cemented onto a CAD CAM titanium abutment extraorally (b) and then fitted as a screw retained restoration (c).
Figure 9
Figure 10: The poorly positioned implant is restored with a cemented single crown estoration.
Figure 11
Figure 12
Figure 13: The patient reported increasing awareness of the lower left first molar implant which had been provided 10 years earlier, and that the crown had debonded on multiple occasions and was now tender to pressure.

References

  1. 1

    Zitzmann N U, Berglundh T . Definition and prevalence of peri-implant diseases. J Clin Periodontol 2008; 35: 286–291.

    Article  Google Scholar 

  2. 2

    Lindhe J, Meyle J ; Group D of European Workshop on Periodontology. Peri-implant diseases: consensus report of the sixth European workshop on periodontology. J Clin Periodontol 2008; 35: 282–285.

    Article  Google Scholar 

  3. 3

    Fransson C, Wennstro¨m J, Tomasi C, Berglundh T . Extent of periimplantitisassociated bone loss. J Clin Periodontol 2009; 36: 357–363.

    Article  Google Scholar 

  4. 4

    Albrektsson T, Zarb G, Worthington P, Eriksson A R . The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986; 1: 11–25.

    PubMed  Google Scholar 

  5. 5

    Roos J, Sennerby L, Lekholm U, Jemt T, Gröndahl K, Albrektsson T . A qualitative and quantitative method for evaluating implant success: a 5-year retrospective analysis of the Brånemark implant. Int J Maxillofac Implants 1997; 12: 504–514.

    Google Scholar 

  6. 6

    Roos-Jansåker A M, Lindahl C, Renvert H, Renvert S . Ninetofourteen-year follow-up of implant treatment. Part II: presence of peri-implant lesions. J Clin Periodontol 2006; 33: 290–295.

    Article  Google Scholar 

  7. 7

    Jemt T, Albrektsson T . Do long-term followed-up Brånemark implants commonly show evidence of pathological bone breakdown? A review based on recently published data. Periodontol 2000 2008; 47: 133–142.

    Article  Google Scholar 

  8. 8

    Albrektsson T, Canullo L, Cochran D, De Bruyn H . 'Peri-implantitis': a complication of a foreign body or a man-made 'disease'. Facts and fiction. Clin Impant Dent Relat Res 2016; 18: 840–849.

    Article  Google Scholar 

  9. 9

    Graziani F, Figuero E, Herrera D . Systematic review of quality of reporting, outcome measurements and methods to study efficacy of preventive and therapeutic approaches to peri-implant diseases. J Clin Periodontol 2012; 39: 224–244.

    Article  Google Scholar 

  10. 10

    Esposito M, Grusovin M G, Worthington H V . Interventions for replacing missing teeth: treatment of peri-implantitis. Cochrane Database Syst Rev 2012; 1: CD004970.

    PubMed  Google Scholar 

  11. 11

    Salvi G E, Carollo-Bittel B, Lang N P . Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks. J Clin Periodontol 2008; 35: 398–409.

    Article  Google Scholar 

  12. 12

    Turri A, Rossetti P H, Canullo L, Grusovin M G, Dahlin C . Prevalence of peri-implantitis in medically compromised patients and smokers: a systematic review. Int J Oral Maxillofac Implants 2016; 31: 111–118.

    Article  Google Scholar 

  13. 13

    Mombelli A, Müller N, Cionca N . The epidemiology of peri-implantitis. Clin Oral Implants Res 2012; 23: 67–76.

    Article  Google Scholar 

  14. 14

    Heitz-Mayfield L J . Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol 2008; 35: 292–304.

    Article  Google Scholar 

  15. 15

    Albrektsson T, Wennerberg A . Oral implant surfaces: Part 1 – review focusing on topographic and chemical properties of different surfaces and in vivo responses to them. Int J Prosthodont 2004; 17: 536–543.

    PubMed  Google Scholar 

  16. 16

    Alani A, Bishop K . Peri-implantitis. Part 2: Prevention and maintenance of peri-implant health. Br Dent J 2014; 217: 289–297.

    Article  Google Scholar 

  17. 17

    Alani A, Bishop K, Renton T, Djemal S . Update on guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS-the position after 15 years. Br Dent J 2014; 217: 189–190.

    Article  Google Scholar 

  18. 18

    Mattheos N, Albrektsson T, Buser D et al. 1st European Consensus Workshop in Implant Dentistry University Education. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus. Eur J Dent Educ 2009; 13: 11–17.

    PubMed  Google Scholar 

  19. 19

    Canullo L, Bignozzi I, Cocchetto R, Cristalli M P, Iannello G . Immediate positioning of a definitive abutment versus repeated abutment replacements in post-extractive implants: 3-year follow-up of a randomised multicentre clinical trial. Eur J Oral Implantol 2010; 3: 285–296.

    PubMed  Google Scholar 

  20. 20

    Swope E M, James R A . A longitudinal study on hemidesmosome formation at the dental implant-tissue overflow. J Oral Implantol 1981; 9: 412–422.

    PubMed  Google Scholar 

  21. 21

    Abrahamsson I, Berglundh T, Lindhe J . The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. J Clin Periodontol 1997; 24: 568–572.

    Article  Google Scholar 

  22. 22

    Rompen E, Domken O, Degidi M, Pontes A E, Piatelli A . The effect of material characteristics, of surface topography and of implant components and connections on soft tissue integration: a literature review. Clin Oral Implants Res 2006; 17: 55–67.

    Article  Google Scholar 

  23. 23

    Grandi T, Guazzi P, Samarani R, Maghaireh H, Grandi G . One abutment-one time versus a provisional abutment in immediately loaded post-extractive single implants: a 1-year follow-up of a multicentre randomised controlled trial. Eur J Oral Implantol 2014; 7: 141–149.

    PubMed  Google Scholar 

  24. 24

    Machtei E E, Frankenthal S, Levi G et al. Treatment of peri-implantitis using multiple applications of chlorhexidine chips: a double-blind, randomized multi-centre clinical trial. J Clin Periodontol 2012; 39: 1198–1205.

    Article  Google Scholar 

  25. 25

    Wadhwani C, Schonnenbaum T R, Audia F, Chung K H . In-Vitro Study of the Contamination Remaining on Used Healing Abutments after Cleaning and Sterilizing in Dental Practice. Clin Implant Dent Relat Res 2016; 18: 1069–1074.

    Article  Google Scholar 

  26. 26

    Cakan U, Delibasi C, Er S, Kivanc M . Is it safe to reuse dental implant healing abutments sterilized and serviced by dealers of dental implant manufacturers? An in vitro sterility analysis. Implant Dent 2015; 24: 174–179.

    PubMed  Google Scholar 

  27. 27

    Ko H C, Han J S, Bächle M, Jang J H, Shin S W, Kim D J . Initial osteoblast-like cell response to pure titanium and zirconia/ alumina ceramics. Dent Mater 2007; 23: 1349–1355.

    Article  Google Scholar 

  28. 28

    Abrahamsson I, Berglundh T, Glantz P O, Lindhe J . The mucosal attachment at different abutments. An experimental study in dogs. J Clin Periodontol 1998; 25: 721–727.

    Article  Google Scholar 

  29. 29

    Park J M, Lee J B, Heo S J, Park EJ . A comparative gold UCLA-type and CAD/CAM titanium implant abutments. J Adv Prosthodont 2014; 6: 46–52.

    Article  Google Scholar 

  30. 30

    Kano S C, Binon P, Bonfante G, Curtis D A . Effect of casting procedure on screw loosening in UCLA-type abutments. J Prosthodont 2006; 15: 77–81.

    Article  Google Scholar 

  31. 31

    Carlson B, Carlsson G E . Prosthodontic complications in osseointegrated dental implant treatment. Int J Oral Maxillofac Implants 1994; 9: 90–94.

    PubMed  Google Scholar 

  32. 32

    Chee W, Jivraj S . Screw versus cemented implant-supported restorations. Br Dent J 2006; 201: 501–507.

    Article  Google Scholar 

  33. 33

    Gjelvold B, Sohrabi M M, Chrcanovic B R . Angled screw channel: an alternative to cemented single-implant restorations – three clinical examples. Int J Prosthodont 2016; 29: 74–76.

    Article  Google Scholar 

  34. 34

    Su H, González-Martin O, Weisgold A, Lee E . Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent 2010; 30: 335–343.

    PubMed  Google Scholar 

  35. 35

    Chrcanovic B R, Albrektsson T, Wennerberg A . Platform switch and dental implants: A meta-analysis. J Dent 2015; 43: 629–646.

    Article  Google Scholar 

  36. 36

    Romanos G E, Javed F . Platform switching minimises crestal bone around dental implants: truth or myth? J Oral Rehabil 2014; 41: 700–708.

    Article  Google Scholar 

  37. 37

    Heitz-Mayfield L J, Needleman I, Salvi G E, Pjetursson B E . Consensus statements and clinical recommendations for prevention and management of biologic and technical implant complications. Int J Oral Maxillofac Implants 2014; 29: 346–350.

    Article  Google Scholar 

  38. 38

    Serino G, Ström C . Peri-implantitis in partially edentulous patients: association with inadequate plaque control. Clin Oral Implants Res 2009; 20: 169–174.

    Article  Google Scholar 

  39. 39

    Haack J E, Sakaguchi R L, Sun T, Coffey J P . Elongation and preload stress in dental implant abutment screws. Int J Oral Maxillofac Implants 1995; 10: 529–536.

    PubMed  Google Scholar 

  40. 40

    Jemt T . Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. Int J Oral Maxillofac Implants 1991; 6: 270–276.

    PubMed  Google Scholar 

  41. 41

    De Araújo Nobre M A, Maló P . The influence of rehabilitation characteristics in the incidence of peri-implant pathology: a case-control study. J Prosthodont 2014; 23: 21–30.

    Article  Google Scholar 

  42. 42

    Berglundh T, Persson L, Klinge B . A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2005; 29: 197–212.

    Article  Google Scholar 

  43. 43

    Quirynen M, Bollen C M, Eyssen H, van Steenberghe D . Microbial penetration along the implant components of the Brånemark system. An in vitro study. Clin Oral Implants Res 1994; 5: 239–244.

    Article  Google Scholar 

  44. 44

    Do Nascimento C, Pita M S, Calefi PL, de Oliveira Silva T S, Dos Santos J B, Pedrazzi V . Different sealing materials preventing the microbial leakage into the screw-retained implant restorations: an in vitro analysis by DNA checkerboard hybridization. Clin Oral Implants Res 2017; 28: 242–250.

    Article  Google Scholar 

  45. 45

    Hebel K S, Gajjar R C . Cement-retained versus screw-retained implant restoration: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997; 77: 28–35.

    Article  Google Scholar 

  46. 46

    Wilson TG Jr . The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol 2009; 80: 1388–1392.

    Article  Google Scholar 

  47. 47

    Korsch M, Obst U, Walther W . Cement-associated peri-implantitis: a retrospective clinical observational study of fixed implant-supported restorations using a methacrylate cement. Clin Oral Implants Res 2014; 25: 797–802.

    Article  Google Scholar 

  48. 48

    Liang T, Hu X, Zhu L, Pan X, Zhou Y, Liu J . Comparative in vitro study of cementing techniques for implant-supported restorations. J Prosthet Dent 2016; 116: 59–66.

    Article  Google Scholar 

  49. 49

    Naert I, Duyck J, Vandamme K . Occlusal overload and bone/implant loss. Clin Oral Implants Res 2012; 23: 95–107.

    Article  Google Scholar 

  50. 50

    Kim Y, Oh T J, Misch C E, Wang H L . Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res 2005; 16: 26–35.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Dawood.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dawood, A., Marti, B. & Tanner, S. Peri-implantitis and the prosthodontist. Br Dent J 223, 325–332 (2017). https://doi.org/10.1038/sj.bdj.2017.755

Download citation

Further reading

Search