Where suitable, dental implants are praised as a method of providing fixed solutions with good longevity, and providing greatly improved retention for removable prostheses, resulting in increased levels of patient satisfaction and quality of life.
However, with increasing evidence of long-term follow-up, there is a growing recognition of the susceptibility of dental implants to peri-implant diseases; peri-mucositis and peri-implantitis. This paper discusses the features of peri-implant disease and important aspects of assessment criteria.
CPD/Clinical Relevance: This paper highlights the importance of supportive maintenance care for patients with dental implants, as well as the features and assessment of peri-implant disease.
Article
Patient demand for dental implants as tooth replacements has increased rapidly over the decades and there are now a wide range of centres providing implant treatments. Dental implants are subject to failure, however, and dental practitioners should be prepared to monitor dental implants for disease and failure such that appropriate management can be implemented. This paper will present an overview of peri-implant diseases including peri-implant mucositis and peri-implantitis and assessment criteria based on current guidelines and evidence.
The peri-implant mucosa provides an important biological barrier which protects the rigid fixation of the implant to the bone from factors released from plaque and the oral environment. This soft tissue attachment to the coronal portion of an implant is necessary for the maintenance of osseointegration and long-term survival of dental implants.
Clinically, peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration.1 In health, there are no visual differences between peri-implant and periodontal tissues, however, histologically a number of distinctions can be made. The peri-implant mucosa is lined by keratinized oral epithelium on the outer aspect, which is continuous with the sulcular epithelium, and a junctional epithelium which attaches to the implant surface by hemi-desmosomal attachment. The junctional epithelium is approximately 2 mm long. The underlying connective tissue is collagen rich, with fewer vascular structures and fibroblasts than that in its periodontal counterpart. The peri-implant tissues lack a periodontal ligament, and derive blood supply from the supra periosteal vessels only. Collagen fibres tend to run in a direction parallel to the implant surface and are said to offer less resistance to irritation and inflammatory effects than that around natural teeth.2,3
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