Dental implants are not the panacea we once thought they were. Indeed, considering the prevalence (at personal level) of peri-implant mucositis is approximately 40%, the occurrence of peri-implantitis is approximately 20%, and the cost of maintaining implants is five times higher than that for teeth, one should not take the prescription of implant therapy lightly.

Implant therapy begins before the implant is placed, and continues for as long as it is in a patient’s mouth. There is an increased awareness of the need to plan long-term supportive care programs during the treatment-planning phase, as well as the financial, biological, and legal consequences of not doing so.

In 2023, the European Federation of Periodontology ‘dropped’ a long-anticipated paper, outlining its findings for the prevention and treatment of peri-implant diseases. This periodontal piece looks at the pre-planning and planning aspect of implant therapy.

Primordial prevention (Prevention of risk factor development)

• Educate the patient on the importance of supportive post-implant care (SPIC) and home care once an implant is placed
• Impress the importance of glycemic control in diabetics
• Encourage smoking cessation
• Get the patient involved in a supportive periodontal maintenance program
• Educate and coach the patient to attain good oral hygiene
• Reduce bruxism and/or parafunctional habits
• Use periodontal therapy to eliminate gingival inflammation (bleeding index <10% is ideal) and achieve periodontal stability

Surgical planning

• Ensure adequate buccal and lingual bone around implant
• Ensure adequate mesial and distal space between the implant(s) and adjacent tooth/teeth to allow for prosthetic components, professional hygiene tools, and home care aids
• Ensure appropriate apical/coronal position to allow for prosthetic components and avoid excess deep sulcus

Prosthetic planning

• Ensure access for professional hygiene tools and home care aids
• Ensure access for professional maintenance tools (i.e. periodontal probe and deposit removal tools)
• Ensure favourable emergence profile to facilitate plaque removal, both professionally and at home

In the next issue of Nova Scotia Dentist, I will discuss how to assess peri-implant health status at each clinical examination, what to do at each implant recall appointment, and how to treat peri-implant mucositis and peri-implantitis. Stay tuned!

Dr. Stacey Matheson is a board-certified periodontist in Halifax and has enjoyed serving Atlantic Canada for more than 20 years. For more information on gum grafting and for educational materials, contact her at 902-406-GUMS (4867) or via perio@halifaxperio.com.

References

• Herrera et al. Prevention and treatment of peri-implant diseases – The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50(Suppl. 26):4-76. doi:10.1111/jcpe.13823
• Gionobile and Lang. Are dental implants a panacea or should we strive to save teeth? J Clin Res. 2016. Jan;95(1):5-6. doi:10.1177/0022034515618942