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implants_international magazine of oral implantology No. 2, 2016

| industry 36 implants 2 2016 A nuanced perspective on periimplantitis Source: Nobel Biocare, Interview by Dr Stefan Holst, Switzerland One of the most widely quoted scientists in dental implantology, Professor Tomas Albrektsson, worries that periimplantitis is increasingly used as an alarm- ing label for benign marginal bone loss around im- plants. On a recent visit to Zurich, Switzerland, he tookquestionsfromDrStefanHolst,NobelBiocare’s Vice President of Implant Systems and Research, on this topic. According to some wide-spread yet crude defini- tions, periimplantitis can be characterised by a periimplantbonelossofaslittleas1.0 mminthefirst year after initial treatment. Since some post-treat- mentbonelossisallbutinevitableduringinitialbone remodelling in even the most successful and long-lasting cases, such definitions lead, as a matter of course, to controversy. Dr Stefan Holst: Periimplantitis is currently a prominent discussion topic at various events and congresses.Isthenatureofthesediscussionsben- eficial for the implantology community or could it be a threat to our reputation? Prof. Albrektsson: When incorrect biological rea- soning is done, it is always a threat. When we look at the clinical outcomes in long-term studies, they are so much better than many of those that we are hear- ingandreadingabout.I’mverycriticalofthis.Itistry- ing to make problems of things that may not be that problematic. The frequency of periimplantitis has been grossly exaggerated in the literature. All bone loss that hap- pens in the first year is definitely not periimplantitis. We see bone remodelling and bone loss for very different reasons. This bone loss is benign in that it doesn’t threaten the implant. Thenwehaveadiseasecalledperiimplantitiswhich, with controlled implants placed by properly trained individuals,isararedisease,butstilloneofsomemag- nitude. With 1–2 % of modern controlled implants showing clear signs of disease at ten years or more of follow-up,wecan’tignoreit.Butwearenothelpedby theexaggerationofthefigures.Thereare13different definitions available for periimplantitis. And we can be without the great majority of those. “We see bone remodelling and bone loss for very different reasons.” Holst: How does a clinician determine whether bonelossisanaturalphysiologicalreactionorthat caused by disease? Albrektsson: From the clinician’s standpoint, we shouldtakealltypesofmarginalbonelossseriously— evenifthegreatmajorityofimplantswithsomebone Fig. 1: Professor Tomas Albrektsson: “The frequency of periimplantitis has been grossly exaggerated in the literature. All bone loss that happens in the first year is definitely not periimplantitis.” Fig. 1 22016

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