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ePaper created 2015-08-07, 10:21:52 | version 1.38.0
21Implant Tribune United Kingdom Edition | 3/2015 TRENDS&APPLICATIONS Open flap debridement, defect de- contamination, and repair as well as pocket elimination have all become the mainstay of those treating this condition. So is there a crisis? The problem is that there is no clear consensus on the prevalence of the disease since this will vary according to the cut off values for the clinical parameters measured24 andtodatethereappears tohavebeenlittleconsensusofthese cut off values. As such estimates of incidence of the disease appear to varyfrom28to56percentofsubjects and12to43percentofimplantsites.25 Furthermore there is an ongoing controversy about the initiating processofperi-implantdiseasesince itispotentiallyconsideredaprimary infectionofperiodontopathicorigin by some26 while others hold that it is a secondary opportunistic infection subsequent to bone loss caused by other etiological factors27 such as a provoked foreign body reaction or iatrogenic dehiscence of the bone, exogenous irritants such as dental cement, bone loss through occlusal overload etc. If the latter is true then controlling the disease is theoreti- cally made more simple by control- ling the conditions for the implant, such as ensuring adequate buccal bone thickness, avoiding or control- ling more carefully the use of dental cement, and paying closer attention totheocclusion. In an effort to gauge the rate of mucositis and peri-implantitis re- quiring surgical intervention, the authorauditedhispatientpoolinthe year2014.Outofatotalof191patient reviews constituting 795 implants only 15 patients (7.9 per cent) re- quired triple therapy at 20 implants (2.5 per cent) for mucositis while 10 patients (5.2 per cent) required surgical decontamination at 10 im- plants(1.3percent). As can be seen this is well below the figures proposed in the article by Zitzmann & Berglundh (2005).25 This may of course reflect a more liberal approach to cut off values forparameterssuchaspocketdepth andbleedingonprobingasproposed Klingein2012. Nonetheless after over 20 years running a practice dedicated to im- plant dentistry the author’s own audited failure rates indicate that less than 1 per cent of implants pres- ent as late failures, owing to peri- implantitis or fixture fracture as a result of bone loss. This would cor- roborate the findings by Jemt et al in which a cohort of patients already diagnosed with peri-implant bone loss showed a slow rate of additional progressive bone loss over a 9-year follow-up with an implant failure rateof3percent.28 In all likelihood it is the author’s view that peri-implantitis is only a crisis if we allow bad implant den- tistry to persist where there is a lack of control of the initiating factors as described above, and that it is more rather than less likely that it is the result of a secondary opportunistic infectionratherthanadirectsuscep- tibility to primary infection of peri- odontopathicorigin.However,there will clearly be some patients with a high genetic susceptibility with other predisposing factors such as the presence of untreated periodon- tal disease, smoking and diabetes who may well succumb as a result of primaryinfection. Furthermorethereremainsaclear need to better define the different types of peri-implant disease and to establishaconsensusastothecutoff values for the different parameters used to evaluate the disease so that future figures for incidence and prevalencearecomparable. Editorial note: A complete list of reference isavailablefromthepublisher. Dr Michael R. Norton runs a practice dedicat- ed to implant & reconstructiveden- tistry in London in the UK. He can be contact- ed at drnorton@ nortonimplants.com AD “...there is no clear consensus on the prevalence of the disease...”