False Conclusions about Peri-Implantitis
In literature we find a number of "factors" which supposedly promote peri-implantitis or cause this disease. We question the claims 1 which mainly place responsibility for the problem on the patient. We consider the wrong choice of implant design the main reason for this widespread disease.
“Factors” typically considered are:
Truth is: Smoking has no influence on bone physiology.
Truth is: Diabetes has no influence on bone physiology.
- Untreated periodontitis (meaning: chronic bacteria-derived inflammation around the remaining teeth, including pockets etc.)
Truth is: in cases of untreated periodontitis (unless all affected teeth are extracted before or on the appointment of the implant placement and if polished implants are used after local disinfection) dental implant treatment is contra-indicated anyway.
- “Periodontal History”
This term does not have a clear definition. If it means that the patient has had a (successfully treated) prior periodontal disease, the question arises why the disease reappeared after initially healing. Perhaps what applies to peri-implantitis also is true for periodontitis: The main cause lies in developments inside the bone. Maybe teeth, just as wide-diameter implants, are an interruption of the bone's continuity, more so than an insert. And we must accept that that both teeth and conventional dental implants are equipped with rough surfaces and both surfaces can be colonialized by bacteria.
- General diseases such as e.g. diabetes or osteoporosis
Truth is: neither osteoporosis nor diabetes have influence on implant survival (after integration) or the development of bony infections around oral implants. Diabetes may influence the development of mucosal infections.
- Medication, e.g. immuno-suppressive drugs
Except Biosphosphonates most immuno-suppressive drugs have no influence on the bone’s physiology.
- Hormonal changes, long-lasting stress
Truth is: neither changes in hormones nor stress influence the bone’s physiology in any way (except for the development of osteoporosis)
- Missing controls
During control appointments the state of the bone can be assessed (e.g. through x-rays or probing), but it is not possible to influence the progression of peri-implantitis. This disease either stops by itself, or it does not stop until the implant (incl. the surrounding bone) is removed.
- Bad oral hygiene
We believe that it is more than questionable to install hygiene-sensitive implant systems (large diameter rough 2 piece implants) into a population which generally (and hopefully) is currently aging: In older age the ability and willingness to clean the implants (or teeth) tends to become less and less. Additionally, phases of unintentional lack of hygiene (e.g. during travels) will accumulate automatically. This triggers the development of the disease. Placing removable constructions on the 2 stage implants (for the purpose of easier cleaning) is generally an unsuitable approach, as some cases displayed on this website show.
The ability to clean the teeth and the implant meticuously will decrease with age. Senior citizens require maintenance free medical devices. Conventional 2 stage implants are therefore generally not suitable for this group of patients.
- Missing osseo-integration
Pre operatively present intra-bony infections may lead to early implant loss due to the fact that the infection (ostitis) prevents osseo-integration and generally keeps a localized high level of mineralization within the bone. But this has nothing to do with peri-implantitis.