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HERRERA ET AL .
FIGURE 5 Levels of prevention for peri-implant diseases. The present guideline deals with primordial, primary and secondary prevention. Primordial prevention involves preventing the development of risk factors for peri-implant diseases, including those introduced at the time of implant placement, for example, position of the implant and cleansability of the prosthesis. Thus, primordial prevention also applies to patients with implants who have healthy peri-implant tissues and no risk factors. However, for the purpose of this guideline, the presence of an implant was regarded as a risk factor for peri-implant diseases (e.g., due to plaque accumulation on a non-shedding surface). Therefore, in the above scheme, primordial prevention does not apply once a dental implant has been placed.
Background
Additional question addressed by the WG
R5.3: Evidence-based recommendation Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
This question was an additional question that was not specifically addressed by the SR and therefore relies upon indirect evidence and on expert opinion. R5.3. During implant-supported prosthesis design and placement, are there specific considerations to reduce the risk of incident peri-implant diseases?
Background
This question was not addressed by the SR and therefore represents an expert consensus-based recommendation, derived from indirect evidence using the cited supporting literature, which may change in the future as new evidence emerges. Expert opinion based on experience is that implant-supported fixed prostheses should have smooth, polished, convex intaglio surfaces, avoid ‘ ridge lap ’ designs and, in general, avoid an over- contoured prosthesis, thus facilitating optimal plaque biofilm removal.
Additional question addressed by the WG
R5.3: Evidence-based recommendation In order to facilitate optimal plaque control around implants and to prevent incident peri-implant diseases, we recommend prosthetic treatment planning should provide for : • good access for to OH aids used by the patient to remove plaque ; • good access for professional monitoring (peri-implant probing) and professional mechanical plaque removal ; • a prosthesis contour with a favourable emergence angle and profile to facilitate optimal plaque control . Supporting literature (De Ry et al., 2021; Grischke et al., 2021; Heitz- Mayfield et al., 2020; Jepsen et al., 2015; Katafuchi et al., 2018; Mattheos, Janda, et al., 2021; Mattheos, Vergoullis, et al., 2021; Serino & Strom, 2009; Soulami et al., 2022; Staubli et al., 2017; Strauss et al., 2022; Yi et al., 2020) Quality of evidence Moderate
5.2
| Recommendations for primary prevention of
peri-implant diseases
The overall objective of this section is to answer the question: in patients with dental implants and peri-implant tissue health, does primary preven- tion involving control of lifestyle and behavioural risk factors prevent the development of peri-implant mucositis and peri-implantitis?
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