Implant indications

Could the harmful effect of deep mucosal tunnels around implants be due to the height of the soft tissue or have something to do with the quality of the fit or the bacteria that might be found at that micro-gap level?

Tonetti: From our study, we were unable to identify whether the reason for this is the hardware and/or the depth of the sulcus. The point is that whenever the mucosal tunnel is deeper (self-performed), professional hygiene seems to be insufficient to remove plaque and keep a healthy interface or reverse experimentally induced peri-implant mucositis. The inflammation therefore can become chronic, and its persistence seems to lead to the onset of peri-implantitis.

Orthopaedic surgeons often talk about ‘repositioning’ after several years and do not expect their prostheses to substitute the natural structures of the joints. However, in implant dentistry we talk about failure rates and extraction of diseased teeth (and replacement with implants) is considered a correct indication. Given this, should we adopt the views and terminology of orthopaedic surgeons, and change the general expectations associated with implant therapy?

Weber: In joint replacement, the best approach is to wait as long as possible. In a similar way we should maintain natural teeth for as long as we can.

Renvert: Infections around teeth are much easier to handle than peri-implantitis. So-called ‘hopeless teeth’ can be maintained for long periods of time; in contrast, trying to keep infected implants is harder. The success rate for treating peri-implantitis is roughly only about 40%. For this reason, the wisest attitude is to take measures to prevent peri-implant infections from the very beginning of treatment.

Tonetti: The biggest issue is that as the population ages and patients are getting older, and sometimes presenting with a very poor general condition, we have to play our cards (i.e. treating diseased teeth, replacing with implants etc.) in the best way we can. To keep our patients chewing, speaking and smiling, the critical question is when to play the cards, and how to modify the game as people get older and more ill.