Dr Nik Sisodia: Dental Implants & Periodontitis

Restoration and Implantology
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Dr Nik Sisodia: Are patients with periodontitis suitable candidates for dental implants?

Co-founder of Ten Dental+Facial, Dr Nik Sisodia explores his key subject, successful dental implant placement…

Many people are seeking to replace teeth that have been damaged or lost due to periodontal disease, and might prove ideal candidates for dental implants. But some dentists are understandably hesitant to provide treatment to these patients. Periodontal disease remains a leading cause of tooth loss among adults, so the issue of successful implant placement becomes an important consideration [1].

The microbiota associated with peri-implant diseases are similar to those that cause periodontal diseases [2]. Therefore, treating patients with past or present periodontitis can be risky due to the fact that periodontal pathogens are able to colonise during the healing period following implant placement, translocating from periodontally compromised teeth to the peri-implant sulcus [3,4,5].

This suggests that the presence of residual periodontal pockets may represent niches of infection for adjacent dental implants, which is a major risk factor for implant failure [6,7]. And patients with a history of periodontitis manifest greater probing depths, more marginal bone loss surrounding implants, and a higher incidence of peri-implantitis compared to those with a healthy periodontium.

However, research currently indicates that there is no significant difference in the rate of implant survival between these two types of patients [8]. Nor is there firm evidence to demonstrate that those with a history of periodontitis experience a higher risk of long-term implant failure than the periodontally healthy [9].

Get it under control

Much of the literature ultimately concludes that appropriate periodontal therapy, adherence to a rigorous periodontal maintenance programme, and limiting of co-morbidity risk factors are critical for ensuring the success of dental implant treatment [10].

Patients presenting with periodontitis must get their condition under control before they can be considered a suitable candidate for dental implants. This would involve the patient undergoing surgical or non-surgical periodontal therapy in practice to mechanically remove bacterial deposits and calculus from the sub-gingivae followed up with an effective oral care regime in order to prevent the build-up of plaque.

Twice-daily brushing with a fluoride toothpaste and regular interdental cleaning is vital and can be supplemented with mouth rinses and other appropriate dental adjuncts. Emphasising to patients the importance of good oral hygiene at home is crucial to successful periodontal therapy, as is providing relevant advice and guidance on how best to clean the teeth and gums. Patients who receive plaque control instructions and reinforcement tend to demonstrate a better response to treatment [11].

Some patients with past or present periodontitis – particularly more advanced forms of the disease – may require a bone or soft tissue graft before an implant can be placed. Adequate quantity and quality of bone is vital for implant stability [12]. A soft tissue graft may be necessary to create the ideal emergence profile and thereby optimising the aesthetic outcome.

Implant maintenance

It is important to establish a strict implant maintenance programme and provide supportive periodontal therapy after successful implant placement. This should be tailored to the individual and involve routine recall appointments so that peri-implant tissues can be monitored for early detection of any post-surgical complications. The patient’s periodontal history and the complexity of dental implant treatment performed should be taken into consideration to establish the most appropriate maintenance protocol.

Recall every three months is adequate for most with a history of periodontitis, but some may require more or fewer visits to the practice, and must understand their responsibilities with regard to implant management. Patients with a history of periodontitis may be considered periodontally healthy at the outset of dental implant treatment, but may benefit from a greater emphasis on self-performed plaque control and additional recall appointments.

It could be worthwhile referring periodontally challenged patients to a specialist for therapy, followed by dental implant placement. Our multi award-winning Ten Dental+Facial team are highly experienced in treating both simple and complex cases. We offer one of the UK’s most seamless and trusted referral services, ensuring patients who are referred to us benefit from the highest quality care.

In conclusion, a history of periodontal disease is not a contraindication to the success of dental implants, so long as patients comply with periodontal therapy before, during and after implant surgery, and careful consideration and management of patients is vital to ensuring long-term success.

For more information, visit www.tendental.com or call on 020 33932623

References:

1] Nazir, M. A. (2017) Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 11(2): 72-80. PMID: 28539867.

2] Mombelli, A., Marxer, M., Gaberthüel, T., Grander, U. and Lang, N. P. (2005) The microbiota of osseointegrated implants in patients with a history of periodontal disease. Journal of Clinical Periodontology. 22(2): 124–130. DOI: 10.1111/j.1600-051x.1995.tb00123.x

3] Pokrowiecki, R., Mielczarek, A., Zareba, T. and Tyski, S. (2017) Oral microbiome and peri-implant diseases: where are we now? Therapeutics and Clinical Risk Management. 13: 1529-1542. DOI: 10.2147/TCRM.S139795.

4] Leonhardt, A., Adolfsson, B., Lekholm, U., Wikstrom, M. and Dahlen, G. (1993) A longitudinal microbiological study on osseointegrated titanium implants in partially edentulous patients. Clinical Oral Implants Research, 4(3), 113–120. doi:10.1034/j.1600-0501.1993.040301.x.

5] Quirynen, M., Vogels, R., Peeters, W., van Steenberghe, D., Naert, I. and Haffajee, A. (2005) Dynamics of initial subgingival colonization of “pristine” peri-implant pockets. Clinical Oral Implants Research. 17(1), 25–37: DOI: 10.1111/j.1600-0501.2005.01194.x.

6] Ramanauskaite, A., Baseviciene, N., Wang, H-L. and Tözüm, T. F. (2014) Effect of History of Periodontitis on Implant Success: Meta-Analysis and Systematic Review. Implant Dentistry. 23(6): 687-696. DOI: 10.1097/ID. 0000000000000156.

7] Singh, V. P., Sharma, A. and Atri, B. (2018) Risk factors associated with dental implant failures. International Journal of Applied Dental Sciences. 4(1): 231-233.

8] Karoussis, I. K., Kotsovilis, S. and Fourmousis, I. (2007) A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clinical Oral Implants Research. 18(6): 669–679. DOI: 10.1111/j.1600-0501.2007.01406.x.

9] Wen, X., Liu, R., Li, G., Deng, M., Liu, L., Zeng, X-T. and Nie, X. (2014) History of Periodontitis as a Risk Factor for Long-Term Survival of Dental Implants: A Meta-Analysis. Int J Oral Maxillofac Implants. 29(6): 1271-1280. DOI: 10.11607/jomi.3544.

10] Hartshorne, J. (2015) Is implant placement a risk in patients with increased susceptibility to periodontitis? International Dentistry – African Edition. 5(2): 32-37.

11] Shaddox, L. M. and Walker, C. B. (2010) Treating chronic periodontitis: current status, challenges, and future directions. Clinical, Cosmetic and Investigational Dentistry. 2: 79-91.

12] Javed, F., Ahmed, H. B., Crespi, R. and Romanos, G. E. (2013) Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation. Interventional Medicine and Applied Science. 5(4): 162–167. DOI: 10.1556/imas.5.2013.4.3.