implants - international magazine of oral implantology

industry report I I 41implants3_2013 Fig. 1a_Peri-implantitis, clinically. Fig. 1b_X-ray of peri-implantitis. _Introduction In the last decades, implantology has emerged as oneofthemostinnovativeenrichmentsinthefieldof dentistry.Considerableincreaseisexpectedinthefu- ture.Comparedtoearlierpreprostheticmethods,en- dosseous implantology is a simple treatment that usuallyisnotverystressfulforthepatientsandoffers many advantages, e.g. the physiological transfer of chewing forces into the bone, which—under certain conditions—evengeneratesrenewedbonegrowth. Against this background, implantology with all its prosthetic treatment varieties is considered an established method. One of the most common and most feared complications occurring in implantol- ogy is peri-implantitis (Figs. 1a & b), which usually leads to implant loss when it remains untreated. Initially, the periimplant tissue disease mani- fests itself as mucositis with progressive bone loss at the implant area, as described by Albrektsson et al.1 Thereasonsforthisdiseasepatternarecomplex, and various hypotheses about the development of peri-implantitis were proposed, amongst them in- sufficientoralhygiene,lackoffixedgingiva,and/or overstressed implants. These putative triggering factors contradict the statements of well-known implantologists, "An absence or insufficient width of keratinized gingiva is not linked aetiologically to thedevelopmentofgingivitisandperi-implantitis" or "The functional strain placed on an implant can- not be solely held responsible for progressive bone loss“.8,17 That means that additional pathologic in- fluences, which trigger and sustain the progress of the disease, must exist next to these ostensible causes. Therapies reach from improved basic hygiene to antibioticsanddisinfectantinsertsintoperiimplant pockets up to ultrasound treatments and laser curettageofinflamedtissues.4,8 Themainattention, however,shouldnotbeplacedontherapy,butrather onto an efficient prevention of peri-implantitis. _Gaps and hollow spaces of assembled implants It is a fact that assembled implants contain hol- low spaces, which can be minimised but not pre- ventedevenbythemostmeticulousproduction.Be- cause threads also hold gaps, the contamination of implant interiors with germs originating from the oral cavity is inevitable.2,11 Re-infection from an implant cannot be ruled out. On almost every assembled implant we noticed a putrid smell of its content, which was extracted withacottontip.In1996weinitiatedexaminations whichconfirmedtheassumptionthatgapsandhol- low spaces in interior implants were contaminated with germs, which matched the germ spectrum of an interdental smear.4,5 9,12,14,15 Implant interiors in their dimensions, position andsizeareeasilyrecognisedbyconstructiondraw- ings,crosssectionalshapesandX-rays,andsoitbe- Peri-implantitis prophylaxis by sealing implant gaps and hollow spaces Author_Prof. Dr Dr Claus Udo Fritzemeier, Germany Fig. 1a Fig. 1b