Implants are a true success story in modern dentistry. In the UK alone, hundreds of thousands of patients have benefited from implant treatment, resulting in a functional, aesthetic and also natural end result. The last Adult Dental Health Survey (ADHS) called implant therapy “an increasingly mainstream part of dental care” and reported that half a million patients now have at least one.[i] This was in 2009 – we can anticipate a swell in the numbers when the next report is published. Over in the US, the implant market is estimated to surpass an astonishing $5.2bn by 2024.[ii] Research and development, leading to advances in technology and technique, are the key drivers for pushing the global market onwards and upwards. We are now hearing a lot about the potential of 3D printing and, in 2017, a Chinese robot performed the world’s first fully automated implant surgery.[iii]
Putting the challenge in context
Back in the UK, implant dentists probably don’t need to worry about the rise of the machines just yet! The main priority is the delivery of safe, stable treatment which has the best chance of long-term success in every unique case. In recent years, peri-implant diseases – which significantly compromise the stability of implants – have received coverage in the dental and general media. In 2014, The Telegraph declared, “Peri-implantitis: The ‘time bomb’ in dental implants”.[iv] Unnecessary scare-mongering? With more implants being placed, are more cases of peri-implant disease simply just a natural consequence (albeit one that must be managed)?
Professional studies about peri-implant disease, specifically peri-implantitis (when the soft tissue around the implant becomes inflamed, leading to bone loss) describe it as “a challenge for the profession, from an aetiologic, diagnostic and therapeutic perspective”, also stating that it has “many disease definitions, leading to varying figures regarding (its) true burden”.[v] Peri-implant mucositis – a plaque-induced inflammatory condition with symptoms including red, swollen gums and bleeding on probing – can be detected at a routine appointment and reversed, before it leads to peri-implantitis. It presents similar to periodontitis on natural teeth; however, around an implant site, any redness and/or swelling isn’t always obvious.[vi] So early diagnosis of peri-implant mucositis is necessary for saving the implant, with an appropriate care plan in place.
Even better, before accepting implant therapy, patients need to understand their role in the treatment’s stability. Effective biofilm management as part of an excellent understanding of oral hygiene and good home care is one of the best things they can do. Other risk factors for peri-implant disease include a history of periodontal disease, smoking and genetic factors.[vii],[viii] The latter opens up exciting possibilities for treatment, with “genetic biomarkers” used for “early identification of individuals predisposed to increased peri-implantitis risk”.[ix]
Prevention and on-going home care
Among patients, there is now a wider acceptance of the value of prevention than there was at the beginning of the last decade. A once-over with a toothbrush twice a day, eschewing routine maintenance appointments and only going to the dentist in an “emergency” like a chipped tooth or chronic pain – this simply isn’t enough to maintain optimal oral health. And for an individual with implants, they need to do much more.
Every-day brushing must be meticulous and patients should be shown how to do this before implant therapy and at every follow-up appointment. Pain and tenderness around the implant site can inhibit thorough cleaning, but with the right tools and correct technique, a gentle yet deep clean is possible to achieve. Brushing must be supported by use of specially selected adjunctive products; implant patients need a kit for home care. This kit should be both preventive and supportive, given to them as soon as treatment has been accepted. If elevated oral hygiene practices start pre-surgery, this can promote healing of the site post-surgery, while also helping to prevent peri-implant diseases. Along with appropriate brushes and interdental cleaning aids, a mouth rinse is essential. Curasept ADS Implant, available from J&S Davis, is a high-quality, anti-plaque formula, to be used for one week before surgery and for a week after. It will slow down the development/accumulation of bacteria and assist both the healing process and tissue regeneration. The product can also be used for support after peri-implantitis treatment and alongside treatment for peri-implant mucositis.
The challenge of peri-implant diseases must be balanced against the incredible advances in implant therapy, which have helped millions of patients across the world achieve a better quality of life. Implant therapy is the gold standard in restoring patients’ teeth in function and aesthetics when the natural teeth have a hopeless prognosis, although patients must understand their part in preventing failure. With more research and education, diagnosis of peri-implant diseases will continue to improve. However, good prevention is everything and with support, more patients will enjoy the long-term benefits of stable, successful implant therapy.
[i] The Health and Social Care Information Centre. Executive Summary: Adult Dental Health Survey 2009, 24 March 2011. Section 4: Complexity and Maintenance. Found at: https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-the4-2009-rep6.pdf (accessed January 2020).
[ii] Dental Implants Market 2019 Detailed Analysis of Current Industry Figures with Forecasts Growth By 2025. Marketwatch, 13 September 2019. Link: https://www.marketwatch.com/press-release/dental-implants-market-2019-detailed-analysis-of-current-industry-figures-with-forecasts-growth-by-2025-2019-09-13 (accessed January 2020).
[iii] A Chinese robot has performed the world’s first automated dental implant. Time, 22 September 2017. Link: https://time.com/4952886/china-world-first-dental-surgery-robot-implant/ (accessed January 2020).
[iv] Peri-implantitis: The ‘time bomb’ in dental implants, The Telegraph, 14 July 2014. Link: https://www.telegraph.co.uk/news/features/10964601/Peri-implantitis-The-time-bomb-in-dental-implants.html (accessed January 2020).
[v] Klinge B, Klinge A, Bertl K, Stavropoulos A. Peri‐implant diseases. European Journal of Oral Sciences. 2018 Oct; 126: 88-94.
[vi] European Journal of Oral Sciences. 2018 Oct; 126: 88-94.
[vii] Fourmousis I, Vlachos M. Genetic risk factors for the development of periimplantitis. Implant Dentistry. 2019 Apr 1;28 (2): 103-14.
[viii] Kasat V, Ladda R. Smoking and dental implants. Journal of International Society of Preventive & Community Dentistry. 2012 Jul;2 (2): 38.
[ix] Implant Dentistry. 2019 Apr 1;28 (2): 103-14.