Forum Implantologicum

This article outlines the definition of peri-implantitis, the clinical features and the prevalence of the disease. The evidence for patient-related and local risk factors for peri-implantitis is presented. A novel risk assessment tool designed for preventing peri-implantitis, the Implant Disease Risk Assessment (IDRA) (Heitz-Mayfield et al. 2020) is explained. The importance of continuous assessment, patient communication and intervention for the minimization and management of risk is highlighted. Keywords: Peri-implantitis, risk factors, risk assessment

For several years, the need for keratinized mucosa (KM) to reduce the risk of peri-implant biological complications has been a controversial topic. Recently, several studies and systematic reviews have confirmed that adequate KM may favorably impact peri-implant health and stability in the long-term. This article will review the recent literature on this topic and suggest clinical guidelines for when to increase peri-implant KM to facilitate surgical handling and enhance long-term maintenance. In conclusion, clinicians should keep in mind that a free gingival graft to increase the width of KM before implant placement may be indicated in situations where the soft tissue is so thin that its manipulation could be particularly difficult, as well as when an implant is already present, but patient reports soreness during oral hygiene procedures. Keywords: Free gingival graft, dental implant, keratinized mucosa, supportive care

Peri-implantitis is a biofilm-mediated inflammatory process that leads to soft- and hard-tissue breakdown. Periimplant diseases are the most frequent biologic implant complication in daily practice. Certain systemic conditions as well as detrimental habits have been demonstrated to negatively impact peri-implant tissue health and stability. In addition, several local predisposing factors were also identified to be associated with the development of periimplantitis, such as the lack of keratinized mucosa, residual cement or a micro-rough implant surface exposed to the oral cavity or the peri-implant sulcus. This clinical review paper will focus on the latter risk factor, which is often caused by poor surgical performance by the clinician during implant surgery. Keywords: Peri-implantitis, peri-implant disease, dental implant, implant infection, risk factor, surgical risk factors

Peri-implantitis is a treatment-related complication with a biofilm-mediated pathogenesis. Several studies have demonstrated that the progression from peri-implant mucositis to peri-implantitis can be effectively managed by supportive implant therapy. However, the impact of implant prostheses on the evaluation of peri-implant tissues, the control of biofilm by oral hygiene and professional prophylaxis as well as the impact of cement or other prosthetic materials on peri-implant inflammation receive little attention. This report will consider prosthesis factors, abutment factors, and cement factors in the evaluation, management and prevention of peri-implantitis. The existing literature clearly indicates that mechanical disruption of dysbiotic biofilm is central to the prevention and management of peri-implantitis. Thus, prosthetic factors that enable or enhance biofilm formation or preclude its mechanical disruption may contribute to the progression of peri-implant mucositis to peri-implantitis. Unfortunately, many of the prosthetic factors that negatively impact peri-implant tissue health are the result of improper implant placement decisions. Both the surgical planning and prosthetic execution of therapy must be addressed in efforts to reduce the risk of peri-implantitis. Keywords: Peri-implantitis, oral hygiene, prosthesis, restorative space, cement