The importance of adequate implant maintenance therapy
Implant therapy for the replacement of one or more dental elements is an effective treatment and exhibits an excellent success rate. The long-term efficacy of a prosthetic implant, or its long-term success, depends mostly on the correct implementation of a maintenance protocol. The latter is so decisive that it deserves to be considered an integral part of the therapy itself, whose effectiveness is closely related to both the patient and the Odontologist.
A correct implant maintenance program should include three fundamental components:
- the practice of correct oral hygiene by the patient, who should avoid exposure to environmental risks such as cigarette smoking, and perform the correct management of any chronic diseases such as diabetes;
- preventive procedures implemented by the Odontologist, such as the removal of supragingival deposits, polishing and elimination of any defects in the dental implant that could increase plaque retention;
- supporting periodontal therapy, i.e. the set of all the interventions necessary to treat causes, pathophysiological mechanisms or sequelae of any dental and oral cavity pathologies.
Customization of the maintenance program and assessment of risk factors
The Odontologist establishes time intervals the controls, as well as the types of surveys to be used from time to time. In general, several studies suggest that the ideal range should range from a minimum of 3 to a maximum of 6 months, as a longer wait would result in an increased risk of post-implant periodontal disease. However, at the time of planning the maintenance program, the Odontologist is required to assess the presence of any risk factors related to both the patient and the type of implant used which suggest the need for more frequent checks or more in-depth investigations. In this way, it is possible to plan a personalized and extremely effective implant maintenance program.
To date, there are no universally recognized evaluation criteria that accurately establish how to set the frequency of checks. However, several studies have suggested many useful factors to identify patients more at risk.
As regards individual risk factors, the suggested variables are the following:
- bleeding rate on probing;
- number of pockets ˃ 4 mm;
- number of teeth lost starting from a total of 28 teeth;
- loss of periodontal support concerning the patient’s age;
- systemic and genetic conditions;
- environmental factors and patient habits.
Particular attention should also be paid to patients with a history of severe periodontitis and poor plaque control, as these are more at risk of developing peri-implant pathologies. Some potentially useful analysis for risk assessment concern the microbiota of periodontal pockets, even if its value has not yet been clearly established: some Authors suggest that the presence of putative periodontal pathogenic bacteria, such as Porphyromonas gingivalis, inside the pockets could increase the risk of alveolar bone tissue loss, while others argue that the quantitative assessment of the microbial load could be more useful than the search for specific microorganisms.
The dosage of metalloproteinases and other proteins within the crevicular gingival fluid has also been proposed as a useful test for assessing the risk of the onset of peri-implant pathologies. However, there are still doubts related to the results high variability, the problems associated with the methods and the absence of a cost-benefit assessment.
Concerning the prescription of any radiological investigations, the ADA (American Dental Association) and the FDI (World Dental Federation) suggest resorting to it only in the case in which they can provide additional relevant information in order to avoid exposing patients to unnecessary radiation.
Importance of the maintenance program: preventing peri-implantitis
The maintenance program is mainly aimed at preventing the biggest complication related to implant therapy: peri-implantitis. This is an inflammatory lesion of the tissues surrounding the implant which can lead to the loss of the supporting bone. Since it is an extremely difficult pathology to treat, as well as one of the most common causes of implant loss, its prevention is very important. To date, although some studies have hypothesized a possible multifactorial etiology, the etiology of peri-implantitis is mainly considered to be of a bacterial nature. The most widespread technique for the prevention of peri-implantitis therefore remains the decontamination aimed at the removal of bacteria, obtained by physical methods (scaling and rootplaning) to which the use of antimicrobial substances, such as minocycline, has recently been associated, which would allow to reach even in the most difficult to access points.
In recent decades, the implantology sector has been the protagonist of great progress and since the maintenance phase of the implant plays an essential role in the long-term success of the therapy, new studies are needed in this area. In the first instance, the local and systemic factors capable of triggering inflammatory processes around the implant, even in the absence of infection, should be investigated, so as to establish new risk markers that help the Professional in drafting an effective maintenance program. Subsequently, long-term clinical studies would be necessary to allow the drafting of real maintenance protocols that also take into account the chemical and physical characteristics of the various implants currently available on the market.
- Berlungdh T. et al, Peri-implantitis and its prevention. Clin Oral Implants Res. 2019;30(2):150-155.
- Yoon D.L. et al, Long-term evaluations of teeth and dental implants during dental maintenance period.J Adv Prosthodont. 2017;9(3):224-231.
- Mellado-Valero A. et al, Decontamination of dental implant surface in peri-implantitis treatment: a literature review. Med Oral Patol Oral Cir Bucal. 2013 18(6): e869–e876.
- Mombelli A., Maintenance therapy for teeth and implants.Periodontol 2000. 2019;79(1):190-199.
- Monje A. et al, Impact of Maintenance Therapy for the Prevention of Peri-implant Diseases: A Systematic Review and Meta-analysis. J Dent Res. 2016;95(4):372-9.
- ADA and FDI. Dental radiographic examinations: Recommendationsfor patient selection and limiting radiation exposure. 2012. http://www.ada.org.