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HERRERA ET AL .
• SPIC is an essential component of implant dentistry; it is critical for preserving peri-implant tissue health/preventing disease onset and must be offered to every patient who receives dental implants. • The aim of treatment is to arrest the inflammatory processes within the peri-implant tissues and to control local and systemic risk factors that may sustain it. Disruption of the locally accumulat- ing microbial biofilms is a key target. • Treatment of peri-implant mucositis is considered a key strategy in the prevention of the onset of peri-implantitis. • Treatment of peri-implantitis is performed sequentially, and encompasses an initial non-surgical step, followed by a surgical step, depending on the outcomes of the initial treatment. SPIC should always be instituted, particularly upon completion of peri- implantitis treatment. The first part of this CPG document (Sections 1 – 4) was prepared by the steering group with the help of the methodology consultant. Section 4, forming the basis for the specific recommendations, was subsequently evaluated by the experts participating in the consensus workshop and voted in a plenary session.
• SPIC programmes for secondary prevention following peri- implantitis treatment may be different from programmes designed for primary prevention.
4.5
| Key aspects in the management of peri-
implant diseases
In addition to the chronological flow of interventions (see Figure 4) and the different steps of therapy depending on the specific peri-implant condition diagnosed, we highlight the following key messages : • Appropriate interventions for the preservation and/or restoration of peri-implant tissue health should be considered before, in con- junction with, and after the placement of dental implants. • Risk factor assessment and control, and diagnosis and monitoring of the health/disease status of the peri-implant tissues, are critical in selecting the appropriate care pathway for the individual patient. • Successful, long-term maintenance of peri-implant tissue health encompasses behavioural modification, health monitoring, appro- priate preventive interventions and, when necessary, careful treat- ment planning and execution. • Peri-implant tissue health, peri-implant mucositis and peri-implantitis represent a continuum. Changes are driven by inflammatory changes subsequent to microbial biofilm accumulation. Controlling inflamma- tion through removal of the plaque biofilm is key to both preserving health and preventing and treating peri-implant diseases. • Preventive and treatment interventions are organized into specific needs-based care pathways. • Prevention aims to attain and preserve peri-implant tissues that are free of clinical inflammation. This is achieved by enabling ade- quate self-performed and professionally delivered OH measures that need to be customized according to the design of implant- supported restorations.
Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
5 | RECOMMENDATIONS FOR THE PREVENTION OF PERI-IMPLANT DISEASES
Risk assessment and risk factor control are necessary to prevent the development of peri-implant diseases in patients who are candidates
FIGURE 4
Chronological flow of interventions, according to implant therapy stage and to the diagnosis of the peri-implant condition.
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