Primary prevention of peri‐implantitis: Managing peri‐implant mucositis

Abstract

Aims: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are -in contrast to periodontitis -at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. Methods: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. Results: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive

Efficacy of two soft-bristle toothbrushes in plaque removal: a randomized controlled trial

“…1 Longitudinal studies have consistently demonstrated that good standards of oral hygiene and regular maintenance reduce the incidence of caries, periodontal disease, and tooth loss, and, more recently, that they improve the outcomes of treatment with dental implants. 2,3,4,5 A classical study related to this topic was performed in Sweden; it demonstrated that a strict oral hygiene regimen reduced tooth loss, the number of new decayed surfaces, and periodontal attachment loss. 3 Other studies have also demonstrated the effects of supragingival plaque control on different oral health parameters, reinforcing its importance as the core of preventive dentistry.…”

How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review

“…This recent paper is in contradiction with the suggestion of Jepsen et al. (2015) that mucositis is a precursor for peri‐implantitis. This contradiction does not imply that one should become negligent and should not strive for the prevention of mucositis with good oral hygiene.…”

Prevalence of peri-implant mucositis

“…A regular periodontal maintenance program is also essential. Jepsen et al 25 reported that inadequate dental biofilm control has been associated with peri-implant disease. Marron et al 7 showed that high biofilm indices (30% or more) may increase the risk of peri-implant disease compared to patients with low index biofilm.…”

“…One should take time to ensure that oral hygiene instructions are properly passed to the patient and that they have understood the importance of effective biofilm control. 26 Thus, the patient's cooperation including biofilm control and attendance to periodontal therapy support are relevant factors to prevent the development of mucositis and periimplantitis [25][26][27] .…”