20
HERRERA ET AL .
FIGURE 1
Management of peri-implant diseases, according to the stage of implant therapy.
of implants in a manner that does not facilitate OH and maintenance ’ (Berglundh et al., 2018). Based on these facts, prevention of peri-implant diseases must also be a focus when: • placing the dental implant, that is, aiming at optimal implant position- ing and considering local factors preventing an ideal placement; • designing and installing the prosthetic reconstruction, that is, con- sidering local risk factors that may prevent access for OH, or if pos- sible, electing screw-retained restorations.
and once the dental implant has been prosthetically loaded and is in function, biofilms can accumulate on their surface, and the ensuing inflammatory process can lead to the onset of peri-implant diseases. Therefore, interventions to prevent peri-implant diseases should com- mence during the treatment plan stage and continue during implant placement and prosthetic rehabilitation. These pre-operative interven- tions should focus on controlling the known risk factors associated with the development of peri-implant diseases, such as smoking, dia- betes, uncontrolled or untreated periodontitis, and inadequate OH practices. These interventions are described in Section 5, and the term ‘ primordial ’ prevention of peri-implant diseases refers to those inter- ventions that can be implemented at the treatment plan stage and tar- get the above risk factors. The concept of ‘ primordial ’ prevention was first introduced by Strasser (1978), as prevention attained through a self-directed lifestyle that precludes the development of risk factors in a population. More recently, the American Heart Association (Lloyd- Jones et al., 2010) has defined the term on a population-wide basis, where primordial prevention is conceived as a strategy to prevent whole societies from experiencing epidemics, while the corresponding strategy on the individual level is to prevent the development of risk factors, consistent with the use of the term in the present guideline, as described in Section 5.
4.2.3 | Post-operative interventions
Once the implants have been exposed to the oral environment, and the prosthetic reconstruction has been installed and is in function, the clinical condition of the peri-implant tissues should guide its manage- ment. Given the reported high incidence/prevalence of peri-implant diseases (described in Section 1), patients should be immediately enrolled into a SPIC programme. SPIC programmes should include interventions for primary prevention of peri-implant diseases, such as professional supra- and sub-marginal plaque biofilm removal and OH motivation and coaching, as well as early detection of pathological conditions.
4.2.2 | Peri-operative interventions
4.3
| Diagnosis of peri-implant conditions
There is evidence in the scientific literature that ‘ dental implants placed under less than ideal circumstances ’ are often encountered in day-to-day practice (Schwarz et al., 2018), which may result in an increased prevalence of peri-implantitis (Berglundh et al., 2018). There is also evidence that prosthetic factors may also increase the risk of onset/progression of peri-implant diseases (Schwarz et al., 2018). In fact, the consensus report from the 2017 Workshop on the Classifica- tion of Periodontal and Peri-implant diseases stated that ‘ there is some limited evidence linking peri-implantitis to factors such as the post-restorative presence of submucosal cement and the positioning
Successful implant-supported rehabilitation requires enrolment in a SPIC, where patients are routinely assessed to facilitate early diagno- sis of peri-implant diseases. The 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions (Berglundh et al., 2018; Renvert et al., 2018) has established clear case definitions for peri- implant health (Araujo & Lindhe, 2018), peri-implant mucositis (Heitz- Mayfield & Salvi, 2018) and peri-implantitis (Schwarz et al., 2018).
Made with FlippingBook Annual report