Nowadays there is rarely a person who does not already have an implant in the mouth due to its widespread use. However, with the proliferation of implants, the problems they cause have also increased, the most serious being peri-implantitis, which almost always leads to the loss of the implant and often of the prosthesis.
How does peri-implantitis affect?
Peri-implantitis is a multifactorial disease, mainly caused by bacteria in dental plaque. However, the risk of suffering from peri-implant pathology increases greatly when the patient has other risk factors. It also depends on the site where the implant is placed, the implant itself and of course the prosthesis.
Patients who may be more prone to suffer from peri-implantitis are those who have had periodontal pathologies, systemic diseases such as diabetes, osteoporosis or hormonal diseases such as thyroid problems. Likewise, patients who have poor oral hygiene, smoke and/or drink too much are also at risk of implant loss.
For the implant not to fail, the chosen site must have a sufficient quantity and quality of bone. It must also have a thickness that allows the implant to be correctly oriented. In addition, the areas where there have been endodontic pieces that have been infected and extracted, or pieces that have had apical granulomas present a higher risk of implant failure.
Influence of the type of implants
Nowadays there is no European regulation on the implant connections, shape and diameters of the screws. In addition, there is an enormous quantity of implants, some of which are no longer manufactured and there is no replacement of parts for them, which presents a serious problem for the patient. There is no justification for this quantity other than the commercial one, making believe that there are advantages with certain measures and shapes, which is not proven at all.
The surface treatment of the implant is one of the most important factors in the development of peri-implantitis. All the treated implants, either by abrasion or deposition of material to make them rough, present a better adherence to the bone and a greater facility for the placement by the practitioner, but the disadvantage of these treated surfaces is that they favor the bacterial contamination enormously, infiltrating the bacteria through the porosities and ending in a few years with the stability of the implant.
The smooth machined surface implants are more unstable, need more waiting time since they are placed and require, on the part of the surgeon, more skill when placing them, but the bacterial contamination in them is much lower, and nowadays they are the ones that give the highest survival rate.
Influence of the prosthesis
The implant-prosthesis connections can be flat or cone-morse type, the cone-morse type in principle would be more watertight, but it has not been demonstrated that it has influence on peri-implantitis.
The prosthesis that is placed over the implants should allow an easy hygiene and cleaning avoiding food retention. It is often difficult to make a prosthesis meet the esthetic criteria that the patient wants and at the same time be compatible with easy cleaning. The patient often erroneously opts for the esthetic side.
A screw-retained prosthesis allows easy and quick disassembly, which is necessary from time to time to clean the prosthesis. However, it presents the problem that the screw access tunnels are difficult to make watertight. In the prostheses cemented to the infrastructure we must remove all the cement challenges that could have overflowed when gluing it. Another very important aspect is the occlusion, which should be balanced and comfortable for the patient.
Whenever implants are placed in a patient, he/she should be warned that the prosthesis he/she has just acquired and the implants require maintenance and observation that will have an additional cost. Large prostheses should be lifted at least every two years, and it will be necessary many times, especially if they have loosened, to place new screws with the corresponding cost. The prostheses should also be subjected to ultrasonic cleaning, correcting the places where the most debris is deposited.
That is to say, the patient should always be aware that he has to take care of his prosthesis, check it, clean it and go to check-ups on his denture. If he is not willing to do this, he should choose another option other than implants.