By Dr. Don Callan
The goal of dental implants is to provide function, longevity and esthetics for dental patients in an environment that can be maintained with routine oral hygiene procedures. Dental implants are no longer experimental, exotic or rare. Implants are the treatment of choice for an increasing number of people who want the best that dentistry has to offer. Dental implants have proven to be a valuable treatment of choice for replacing missing teeth and have been developed from the anatomy of natural teeth. Dental implants are also subjected to periodontal disease (periodontitis) caused by oral bacteria (periodontal pathogens). Both patients and dentists should be aware of possible complications that can affect the patient’s oral and systemic health when implants are placed, even if excellent esthetic results are achieved. Professional implant maintenance and diligent patient home care are important factors. However, because a portion of the implant is below the gum level (subgingival), patients and clinicians have limited control over hygienic measures to prevent infection. Therefore, implant design is an important factor.
Periodontal pathogens have been linked with increased risk of systemic illness and complications in existing diseases. Recently, several articles detailing these findings have been published, emphasizing the importance of the association between periodontal disease and systemic health problems. In fact, recent reports of oral infections have been shown to be associated statistically with mortality. With periodontal disease, millions of oral bacteria are in direct physical contact with gum tissue, which provides an easy portal to the circulatory system. After entering the bloodstream, periodontal pathogens have been shown to increase the risk of cardiovascular disease, strokes, lung disease, rheumatoid arthritis and may hinder glycemic control in diabetes. Sufficient evidence exists to conclude that both periodontitis and Peri-Implantitis involve the same bacteria. This same inflammatory process can damage healthy tissue and lead to bone loss around the implant.
In addition to optimizing esthetic and functional results, infection (Peri-Implantitis) of gum and bone tissue surrounding the implant is of major concern. These infections have driven many developments in dental implant design and use. Treatment of dental patients is rapidly moving from an approach focused primarily on esthetic and functional concerns toward an approach, which focuses on optimal health as a critical goal. Numerous published studies promote the prevention of oral bacteria harboring around implants as a key outcome in addition to traditional measures of implantation success.
Studies have shown periodontal pathogens surrounding dental implants will contribute to implant infections and is the main cause of implant loss and systemic concerns. Some patients may have significant infection and bone loss with no symptoms and may not pursue adequate follow-up care that would identify those conditions. Researchers have identified specific periodontal pathogens around and within the micro-gap of implant systems as the same seen in periodontal disease. Some implant companies are developing new designs for the elimination of the microgap issue. Therefore, it is important for all implant patients to see the dental professional for routine care and evaluation of the health around the implant. It is possible for patients who maintain optimum hygiene care to suffer from implant infections if bacteria are harbored within, around, and between implant components.
In summary, the patient, dentist and the implant manufacturer have their respective areas of responsibility to maintain implant success. Infection about dental implants is the number one cause of failure; therefore, the patient must maintain excellent home care procedures of the implant and visit the dental office for routine cleanings. The dentist is responsible for proper surgical procedures and instruction to the patient for home care procedures. The implant manufacturer must be aware of the causes of implant failures in order to change or correct the design of dental implants as needed to promote long-term success. A poor implant design will affect esthetics, function and the ability to allow proper home care as well as professional cleanings of the implant and its restoration. IMPLANT SUCCESS IS A TEAM EFFORT: THE PATIENT, DENTIST AND MOST OF ALL THE MANUFACTURER OF THE IMPLANT.
Dr. Callan received his B.S., B.A. degree from the University of Arkansas in Business Management and Marketing. He received his D.D.S. degree and a Certificate in Periodontics from the University of Missouri at Kansas City. Dr. Callan maintains a private practice and hospital appointments limited to Periodontics with an emphasis on tissue regeneration and implant dentistry in Little Rock, Arkansas. Dr. Callan has authored 61 publications about dental implants and tissue regeneration. Dr. Callan has presented lectures in the United States and internationally, including the University of Moscow, Russia, China, Japan, UK, Mexico, Canada, Central America, and South America, on various topics including dental implants, Peri-Implantitis, bone regeneration, soft tissue regeneration, implant maintenance, oral and systemic periodontal health, marketing to the dental patient and treatment planning of the edentulous patient.