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HERRERA ET AL .
peri-implantitis concluded that pain levels were low to moderate and most pronounced in the first 2 days (Norum et al., 2019).
Of relevance is the cost comparison of SPIC with that of the sup- portive care of teeth. This was assessed in a private practice in Norway (Fardal & Grytten, 2013) in 43 patients with 847 teeth and 119 implants. The mean number of ‘ disease-free years ’ was 8.66 for implants, 9.08 for neighbouring teeth, and 9.93 for teeth on the contra-lateral side of the mouth, with no statistically significant differ- ences. However, due to the high prevalence of peri-implantitis, the extra cost of maintaining implants was five times higher than for teeth. Finally, financial considerations should include the economic impact of edentulism. While not yet clearly established, at least two factors may support its importance: firstly, the need for rehabilitation and the associated costs; secondly, and in case of lack of rehabilita- tion, the negative consequences for quality of life, nutrition, systemic health and well-being. In addition, it is also widely contended that individual- and community-level social inequalities strongly impact on levels of edentulism (Ito et al., 2015).
1.1.5 | Financial aspects
According to a market analysis report (Grand View Research, 2022), the global market size of dental implants is esti- mated at US $4.6 billion in 2022 and is expected to grow at an annual rate of around 10%, up to 2030. The increase is based upon the demand for treatment with dental implants by the pop- ulation and on the widening range of clinicians providing implant therapy. It is also associated with the growing need for longer term supportive care to avoid/control biological and mechanical complications, including managing complications with implant- supported restorations and maintaining peri-implant tissue health (Alani et al., 2014). There is increasing awareness of the need to plan long-term supportive care programmes during the treatment planning phase, and of the financial, biological and legal conse- quences of not doing so. For example, patients may be able to cover the initial cost of dental implants and their associated res- torations at the time of implant placement, when they are employed and earning a living, but the long-term cost of sup- portive care may not be explained clearly to patients and may impact when they are no longer economically active (Alani et al., 2014). A Swedish study of 514 subjects recently calcu- lated such costs (Karlsson et al., 2022), including the costs of preventive measures and of procedures to treat implant compli- cations, over a period of 8.2 years. The mean cost ranged from € 878 (single-tooth restoration) to € 1210 (full-arch restoration), the larger proportion of the cost being for prevention ( € 741), while implant loss was the most expensive complication ( € 1508), followed by peri-implantitis ( € 1244). A cost-effectiveness analysis was undertaken to assess preven- tive, non-surgical and surgical interventions (Schwendicke et al., 2015), with the model assuming that each implant was followed for 20 years. The annual provision of SPIC was dichotomized and the risk profile of patients was also considered, with implant loss and cost as primary outcomes. For management of peri-implantitis, 11 approaches (non-surgical and surgical instrumentation alone or with adjuncts) were compared. The authors concluded that, within the limitations of their study methodology, not providing annual SPIC increased the risk of peri-implant diseases. Conversely, providing SPIC could prevent or delay the onset of disease and was cost-effective, especially in high-risk groups. Cost-effectiveness has also been evaluated for non-surgical treat- ment approaches of peri-implantitis (Listl et al., 2015). Change in PD was the primary outcome when comparing eight interventions. Instru- mentation alone, use of an air-polishing device, or combining instru- mentation with local antiseptics/antibiotics provided better value for money than Er:YAG laser, a specific ultrasonic device (Vector ® ), pho- todynamic therapy (PDT) or instrumentation combined with chlorhexidine.
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AIM OF THE GUIDELINE
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This guideline aims to identify best practice interventions for preserv- ing the health of peri-implant tissues and, thereby, extending the lon- gevity of complication-free survival of dental implants when used to replace missing teeth. The main objective, therefore, is to summarize the evidence-based recommendations for individual interventions used in the management (both prevention and treatment) of peri- implant diseases, based on the best available evidence and/or expert consensus. In so doing, this guideline aims to: (i) inform sound preven- tive/therapeutic approaches to the management of peri-implant dis- eases, and thereby improve the overall quality of peri-implant interventions undertaken in Europe and worldwide; (ii) reduce dental implant loss arising due to peri-implantitis; and (iii) ultimately reduce medical and dental costs and improve the quality of life of patients.
2.1
Target users of the guideline
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Oral health professionals, together with stakeholders, related to oral health care. In addition, this CPG aims to inform medical professions, health systems, policymakers, patients and the public.
2.2
Target environments
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Academic/hospital environments, community-based dental clinics and practices.
2.3
Target patient population
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People awaiting dental implant rehabilitation.
People receiving dental implant rehabilitation.
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