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ePaper created 2016-05-19, 12:42:25 | version 1.38.0
industry | 372 2016 implants loss will never develop periimplantitis. The problem is that we don’t know which ones. Forexample,onereasonforproblemswithboneloss is cement remnants in the soft tissue. If you remove thatintime,thebonelossstops.Theimplantcanfunc- tion happily ever after, without any problems. But thereisalsothepossibilitythatifyouleavethecement remnants in place for 10, 15 or 20 years, then periim- plantitis may follow with the same implant. A clinician should always take action when he or she sees marginal bone loss or rather the preface of it,whichiscalledmucositis.Mucositisisonlythefirst sign of an immunological reaction; it has nothing to do with anything else but immunology, which is un- fortunately not understood by many of our clinical colleagues. Holst: Recent studies based on the Swedish popu- lation imply that implant brand plays a role in periimplantitis.Isthisnotmisleadinggiventhatso many factors influence treatment outcomes? Albrektsson: Many of the figures that are being quoted,bethatintherecentSwedishpublicationor others, are lamentably unrealistic. They have used the most liberal definitions they can find of what theycalladiseasewheninrealityitisnosuchthing. Ourownstudiesoflong-termfollow-uponimplants demonstrateveryclearlyasimilar,smallpercentageof implants that are hit by periimplantitis, they are be- tween1and2 %,whetheryoupreferoneofthemajor implantsystemsortheother,isnodifference. But implant systems that say they are similar to other documented implants, and therefore need no documentation of their own, are not to be trusted. Cliniciansneedtopickanimplantsystemthathasits own documentation published in peer-reviewed pa- pers. If that doesn’t exist, don’t buy it. Never forget that buying a cheap implant that is undocumented can prove to be very expensive. Holst: Based on your clinical experience, what are the factors that play a role? Albrektsson: It is complications to treatment that cause bone loss. We call it the “Triad of Poor.” First, poorimplantsystems.Asmentioned,theseexistand are sold at a cheap price. Again, you should avoid these implant systems. Secondispoorclinicalhandlingbyclinicianswith- out the right skills. Finally there is what we can term poor patients—those patients that are difficult to treat. These are the causes of bone loss, that in rare, but in some cases, may in the long-term lead to periimplantitis, but in most cases not. Holst: So what can we, as dental implant profes- sionals, do to prevent the proliferation of misin- formation about periimplantitis? Albrektsson: I’m increasingly irritated with people calling benign bone loss a disease. Those who are do- ing so have to read the new research that’s out and realise they are wrong. And the profession must, in a united manner, pro- test against alarming reports in a much stronger manner than we have done to date. But at the same timewemustofcoursecontinuetotakepatientsvery seriously.Wecannotignoreboneloss,evenifitproves to be benign. We have to be active all the time and work to the best of our knowledge for our patients. More to explore! For more to read about this and related topics—such as findings about screw vs. cement retention—please visit: nobelbiocare.com/ news._ contact Nobel Biocare Services AG P.O. Box 8058 Zurich-Airport, Switzerland www.nobelbiocare.com Fig. 2: Stick with the original. “Implant systems that say they are similar to other documented implants, and therefore need no documentation of their own, are not to be trusted.” Fig. 3: Dr Holst: “What can we do to prevent the proliferation of misinformation about periimplantitis?” Prof. Albrektsson: “We must protest against alarming reports in a much stronger manner than we have done to date.” Fig. 3 Fig. 2 3722016