Hierarchical decisions on teeth vs. implants in the periodontitis‐susceptible patient: the modern dilemma

Abstract

It is estimated that advanced periodontitis typically affects about 10% of most adult populations studied. These individuals can be considered highly susceptible to periodontitis and often present difficulties for clinicians in therapeutic decision making, especially when dental implants are involved. Poor plaque control and smoking are well established risk factors for periodontitis, as well as for peri-implant disease. Long-term follow-up studies have clearly demonstrated that treatment of periodontal disease, even if advanced, can be successful in arresting disease progression and preventing (or at least significantly delaying) tooth loss. With the increasing development of implant dentistry, traditional well documented and evidence-based therapies to treat periodontal diseases may sometimes not be used to their full potential. Instead, there appears to be an increasing tendency to extract periodontally compromised teeth and replace them with implants, as if implants can solve the problem. However, peri-implant diseases are prevalent, affecting between 28% and 56% of people with implants, and (at the implant level) 12-43% of implants. A history of periodontal disease, smoking and poor oral hygiene are all risk factors for developing peri-implantitis. Unlike periodontitis, there are currently no predictable means for treating peri-implantitis, although resective surgery seems to be the most effective technique. Consequently, if implant treatment is considered in patients who are susceptible to periodontitis, it should be preceded by appropriate and adequate periodontal treatment or re-treatment to control the condition, and should be followed by a stringent supportive maintenance program to prevent the development of peri-implant disease. The decision whether implant treatment should be performed should be based on an assessment of the patient's risk profile at the subject level, as well as at the site level.

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

“…2,3 Ti dental implants have shown excellent survival rates in the past years, 4 however, the issue of bacterial colonization remains a problem as biofilm formation on the implant surface can lead to loss of osseointegration with subsequent treatment failure. [5][6][7] Thus, many chemical disinfection protocols have been developed to try and clean implants after surface infection, in hopes of avoiding surgical intervention and increase the survival rates of affected implants. 8 Biofilm formation comprises of a series of stages, starting with the initial adhesion of early colonizing species 9 and continued by the attachment of secondary and increasingly pathogenic bacteria that can lead to disease.…”

Stabilizing periodontally compromised teeth with glass fiber-reinforced composite resin – case report

“…Teeth with mobility were not more susceptible to greater insertion loss over time [6], but these teeth may cause masticatory discomfort, as reported in this clinical case. Thus, the splinting restores the functional occlusion and the masticatory comfort, improves the esthetics, and promotes the psychologic well-being of the patient [12].…”

Factores de riesgo y periimplantitis en la terapia implantológica. Revisión narrativa.

“…Donos et al 32 consideran que los implantes dentales deben ser el tratamiento de piezas pérdidas mas no para la sustitución de piezas dentarias. Por tanto, la conservación de piezas dentarias que se mantengan funcionales debe ser el fin principal de la terapia periodontal.…”