Prof. Renvert, ten years after implant placement, seven percent of implants are lost and about fifteen percent of patients suffer from peri-implantitis.1 Can this be attributed to poor implant placement planning?
Prof. Renvert: To attribute all those cases to a failure in treatment planning or placement of implants would be too easy, but I think it is really important to put a greater focus on risk assessment before placing an implant.
Several factors can make an individual susceptible to peri-implantitis. Which correlations have a good evidence-basis?
Prof. Renvert: History of periodontitis and bad oral hygiene are definitely related. There are also reasons to believe that smoking has a negative impact, and systemic conditions such as diabetes or cardiovascular disease may play a role. So, when someone suffers from those conditions, it might be necessary to compensate for an increased risk when placing an implant by reducing other risk factors.
A person with poor oral hygiene is reported to be 14 times more prone to develop peri-implantitis, and a person with a history of periodontitis and no maintenance therapy is 11 times more prone. What conclusions can practitioners draw from these numbers?
Prof. Renvert: If we place implants in patients with a history of periodontitis, it is crucial to discuss the higher risk for peri-implantitis with them openly and to make it clear that good oral hygiene is needed in order for them to keep their implants. “New teeth for a lifetime” is not realistic without lifting a finger. Additionally, one should definitely reduce risk factors for those patients wherever possible, for example: consider where we place the implant, make it possible to clean the implant properly and urge patients to quit smoking. There are also good reasons to prefer screw-retained over cemented reconstructions in order to reduce the risk for what some people call “cementitis.”