Implants have high long-term success equal to or greater than root canal therapy, with the vast majority of implants lasting ten years or more. Modern root-form implants occupy the natural space left by an extracted tooth, thus having minimal interaction with the surrounding tissue and helping to retain bone height thanks to the stimulation of occlusal forces.
However, implants are not immune to developing problems. Sometimes, plaque can irritate the gingival tissue surrounding the implant's coronal portion. This peri-implant mucositis is usually detected by periodontal probing, which is why most clinicians opt to take baseline pocket depth values during loading of the implant, and monitor the site closely in follow-up appointments. If untreated, peri-implant mucositis can progress to peri-implantitis, an inflammation in the osseous tissue surrounding the implant. This inflammation can lead to crestal bone resorption, mobility, and ultimately the failure of the implant.
So, how can a clinician prevent a new implant site from developing this pathology? Common preventative steps are focused on monitoring the site, using baseline radiographs and periodontal probing depths upon placement of the restoration, and follow-up examination to detect any changes as early as possible. Successful implant dentists are always on the lookout for periodontal symptoms indicating inflammation!
Patient education is imperative to ensure long term success of implants. Remember that many patients believe that "a fake tooth can't rot," and will need reminding that an implant interacts with the mouth just like a natural tooth and therefore must be brushed and flossed to keep it healthy. Implants are particularly susceptible to the effects of smoking, since they rely on the proper functioning of the body's repair systems to integrate. These repair systems are significantly hindered by the chemical changes produced by smoking.
Exciting new technologies are being developed both to prevent and treat peri-implantitis. Researchers at Tokyo Medical and Dental University have successfully developed a method to dissolve ozone nanobubbles in water, producing a gentle and highly antibacterial agent that can penetrate deep into periodontal pockets. This could replace traditional, harsher antiseptics used when inflammation has been detected at the peri-implant region. Another report, presented at the recent 45th Annual Meeting and Exhibition of the American Association for Dental Research, demonstrates that a treatment containing minocycline microspheres can successfully improve or even reverse peri-implantitis in many cases. The microspheres are applied to the periodontal pockets and slowly release antibiotics over a period of weeks, allowing the body's tissues to heal around the implant.