Special issue: Peri-implantitis 1 September 2013
Author: Hadi Antoun
Journal and references: Le fil dentaire N°85-Septembre 2013
The predictability of dental implants is unquestionable since the beginning of their application in the early 80s. However, with the steady increase of their use, the occurrence of peri-implantitis is on the rise in the medium and long term.
The definitions of mucositis and peri-implantitis, detailed in the first article, vary among the variousconsensus and scientific societies that have worked on the subject.
However, the prevalence of this diseasevaries greatly from one study to the next. According to Lekholm in 1986, osseous loss after 7.6 years of loading was not significant, whereas Koldsland reported in 2010 a rate of 37% of peri-implantitis in implants and in 41% of the patients under study. These alarming figures and the visit in our practices of patients affected with more or less serious peri-implant osseous loss, which are often difficult to control, have led us to question this subject. In 2012, Renvert compared two types of sandblasted implants using balls of titanium oxide with an acid-etched surface over a period of 13 years. The incidences of peri-implantitis were of 32% for one and 40% for the second, with no significant difference. His statistics included cases with at least 1mm of osseous loss after one year, and with bleeding on probing (BOP) or suppuration. Another team (Mir-Mari 2012) recently showed a peri-implantitis prevalence in 9,6% of patients and in 16.3% of implants. Their definition of peri-implantitis was an osseous loss of 2 or more threads, with bleeding on probing or suppuration.
What about patients with periodontal disease?Are there any association between periodontal disease and peri-implant osseous loss? Swiekort (2012) reported that patients treated for rapidly progressive periodontitis were(10%). 14 times more likely to develop a peri-implantitis (26%) than an individual with a healthy periodontium (10%). Moreover, Cho-Yan Lee (2012) compared subjects with a history of periodontal disease to another healthy group. Using a probing pocket depth of more than 5 mm and bleeding on probing, the prevalence was 27% for the patients with periodontal disease and 13% for the patients considered healthy. Using the x-ray as signs of disease with a marginal bone loss of more than 3 mm, the prevalence dropped to 9% and 3% respectively.
What about immediate extractions/loading?Could they increase the risk of peri-implantitis? Rodrigo (2012) found the same rate of peri-implantitis of 6% at 5 years, with immediate or delayed implants, considering more than 4 mm probing pocket depth and bleeding on probing.
What about the importance of prevention?Several studies have demonstrated that the incidence of peri-implantitis decreased in patients who were on a maintenance programme. Costa (2012) showed a rate of 18% in patients who were being followed as compared to others who were not and had a rate of 44%. The recent conference consensus in Spain concluded that the rate of peri-implantitis was of only 2.7% over a period of 7 to 12 years (Albrektsson 2012). These conclusions are primarily based on the results of three studies; Buser (2012) with a prevalence of 2%, Degidi (2012) with 8%, and Östman (2012) with 2%. The definition considered in these peri-implantitis studies was similar to the one used in the consensus conference whichis the following: "The peri-implantitis term defines an infection with suppuration associated with a progressive osseous loss after a bone remodelling period."
Finally, the prevalence of peri-implantitis varies as seen through the various studies. It also varies according to the population under study, but alsoaccording to the definition used, making it urgent to unify. Despite the multiple studies and consensus conferences, these do not allow to extract a clear idea of the prevalence of this disease. Based on that observation, it seems clear that it will be difficult to draw definite conclusions on possible treatments.
Nonetheless, through this special issue of "Le Fil Dentaire" inspired by the serious bibliographic thesis recently defended by our colleague Jeremy Abitbol (2013), we wished to enlighten readers as much as possible on the importance of this disease by understanding its etiopathogeny and the influence of surface conditions, by analysing the different treatment options available and, finally, by stressing the importance of maintenance after implant placement.
Read the complete article: here
