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.


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.

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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.


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Dawood, A., Marti, B. & Tanner, S. Peri-implantitis and the prosthodontist. Br Dent J 223, 325–332 (2017).

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