Implications of considering peri‐implant bone loss a disease, a narrative review

Abstract

Background Peri‐implantitis has been suggested to cause significant increasing proportions of implant failure with increasing time. Purpose To assess whether implant failure rates in long term studies are matching the supposed high prevalence of peri‐implantitis. Material and Methods This paper is written as a narrative review of the long‐term clinical investigations available in the literature. Results Some implant systems have seen unacceptable marginal bone loss figures with time coupled to increased implant failure rates, resulting in the withdrawal of these systems. The reasons for such mishap are generally unknown, with the exception of one system failure that was found to be due to improper clinical handling. Modern, moderately rough implant systems have functioned excellently over 10–15 years of follow up with minor problems with marginal bone loss and implant failure rates within a few per cent. Machined implants have functioned adequately over 20–30 years of follow up. Implant failures occur predominantly during the first few years after implant placement. No significant increase of implant failures has been observed thereafter over 20–30 years of follow up. Over the years of our new millennium, scientific and technical advances have allowed the discovery of numerous molecular pathways and cellular interactions between the skeletal and immune system promoting the development of the interdisciplinary field called osteoimmunology. Nowadays, this knowledge has not only allowed the emergence of new etiologic paradigms for bone disease but also a new dynamic approach on the concept of osseointegration and MBL around oral implants, re‐evaluating our older disease oriented outlook. This facilitates at the same time the emergence of translational applications with immunological perspectives, scientific approaches based on omics sciences, and the beginning of an era of personalized dental implant therapy to improve the prognosis of oral implant treatment. Conclusions Oral implant systems have been found to function with very good clinical outcome over follow‐up times of 20–30 years. Registered implant failures have occurred predominantly during the first few years after implantation, and there has been no significant increase in late failures due to peri‐implantitis.

Exploring the Importance of Corticalization Occurring in Alveolar Bone Surrounding a Dental Implant

“…However, the authors did not point out the corticalization. Similarly, this is seen in Figure 5 in Albrektsson’s publication [ 93 ]. Today, the phenomenon of bone density increase can be analyzed qualitatively and, of course, in relation to the MBL [ 44 , 45 ].…”

Risk Characteristics of Peri-Implant Infections: A Retrospective Evaluation in a University Consultation Setting

“…Data regarding implant systems and implant surface characteristics were not presented in this study due to the wide variety of systems from various companies. A recent review revealed good long-term survival rates independent of implant surface and roughness [ 34 ].…”

“…Certain genetic predispositions to peri-implantitis, such as tumor necrosis factor-alpha (TNF-⍺) or interleukin-1 (IL-1) polymorphisms, showed potential links in the onset of peri-implant diseases [ 35 , 36 , 37 ], although clear genetic patterns are still to be determined. In addition, immune-centered therapeutic approaches to improve osseointegration and prevent bone loss around implants were recently proposed in a review by Albrektsson et al, who emphasized the role of foreign body reaction and host response in the development of peri-implantitis [ 34 ]. These may account for the small percentage of patients with no clear risk factors identified in the present review.…”

Implantogenomic: Conceptualizing Osseointegration toward Personalized Dental Implant Therapy

“…More recently, Albrektsson et al proposed that personalized dental implant therapy and its implantogenomics concept may accelerate the development of genetic diagnostic tests as a target future therapeutic for residual ridge resorption (RRR) in elderly [16,93]. In this regard, it should be mentioned that the application of personalized dental medicine to the realm of dental implant requires innovative leadership to direct wide-spectrum of scientific and clinical research as well as multidisciplinary and multicenter collaborations.…”