Prevention and treatment of peri‐implant diseases—The EFP S3 level clinical practice guideline

Abstract

Background The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I–IV periodontitis provided evidence‐based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri‐implant diseases were also re‐defined in the 2018 classification. It is well established that both peri‐implant mucositis and peri‐implantitis are highly prevalent. In addition, peri‐implantitis is particularly challenging to manage and is accompanied by significant morbidity. Aim To develop an S3 level CPG for the prevention and treatment of peri‐implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri‐implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri‐implant diseases. Materials and Methods This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders. Results The S3 level CPG for the prevention and treatment of peri‐implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri‐implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri‐implant care programme should be structured, including periodical assessment of peri‐implant tissue health. If peri‐implant mucositis or peri‐implantitis are detected, appropriate treatments for their management must be rendered. Conclusion The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri‐implant tissues, and to manage peri‐implant diseases, according to the available evidence at the time of publication.

Surface decontamination of explanted peri‐implantitis‐affected implants

“…In this context, our choice of a 60-s instrumentation was based on clinical/ practical considerations. It should also be noted that AP during surgery is currently not recommended (Herrera et al, 2023). In one of the few clinical evaluations on the topic, Hentenaar et al (2022) failed to identify any clinically relevant benefits of AP in the surgical treatment of peri-implantitis.…”

“…The consensus report also stated that the purpose of a surgical approach in the management of peri-implantitis is to provide access to the implant to facilitate surface decontamination. Although a standard surgical procedure was suggested to include cleaning/ decontamination of the implant surface using, for example, small pieces of gauze soaked in saline and removal of mineralized deposits with curettes, additional implant surface decontamination procedures were suggested to include mechanical/physical methods and/or chemical agents (Herrera et al, 2023). Results from systematic reviews performed in conjunction with the EWOP indicated that only few controlled studies exist on additional implant surface decontamination methods (Ramanauskaite et al, 2023;Wilensky et al, 2023).…”

“…The goal of treatment of peri‐implantitis is to resolve inflammation and to arrest further loss of the supporting bone. In a consensus report from the XVIII European Workshop on Periodontology (EWOP), clinical practice guidelines on treatment of peri‐implant diseases were established (Herrera et al, 2023). It was reported that the management of peri‐implantitis is challenging and associated with significant morbidity.…”

“…Results from systematic reviews performed in conjunction with the EWOP indicated that only few controlled studies exist on additional implant surface decontamination methods (Ramanauskaite et al, 2023; Wilensky et al, 2023). Hence, recommendations on their use were in general careful and negative (Herrera et al, 2023).…”

Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: A translational study

“…For dental implants, a prosthetically guided position is considered important for long-term implant health (Herrera et al, 2023).…”