New consensus paper seeks to separate peri-implantitis fact from fiction

Peri-implantitis is one of the most controversial topics in dentistry, with ongoing debate about whether it can be classified as a disease or should be considered as a complication of placing a foreign body in the oral cavity.

Now, a new consensus report led by Professor Tomas Albrektsson (right) presents the outcomes from a consensus meeting on peri-implantitis in Rome, Italy, which took place January 8–10, 2016.

Published in Clinical Implant Dentistry and Related Research, the paper presents the conclusions of 17 clinical scientists who were invited to discuss topics related to peri-implantitis based on prepared reviews of the literature.

The meeting was sponsored by grants from gold sponsors Nobel Biocare, Straumann, Dentsply Sirona and Southern Implants.

Get the news straight to your inbox – sign up for our monthly newsletter

10 conclusions

The paper by Albrektsson, et. al., lists the following conclusions:

  • “Peri-implantitis” is not a clearly defined condition.
  • There is no evidence in the literature that a specific peri-implant disease exists as a unique entity with a specific etiology and pathogenesis.
  • Progressive marginal bone loss (MBL) after the first year of the implant commonly depends on a complication to treatment that is unrelated to “disease”.
  • A one-time radiograph after baseline radiography is insufficient to diagnose “disease”.
  • To diagnose peri-implant health, we need a series of radiographs from different times of follow up to decide whether a particular implant has progressive loss of marginal bone or not.
  • Periodontal indices such as bleeding on probing and probing depth are not reliable diagnostic tools for identifying “peri-implantitis.”
  • There is no clinical evidence published that modern, moderately rough implants will display more “peri-implantitis” than older turned or plasma sprayed implants.
  • Peri-implant inflammation is not necessary equal to progressive “disease.”
  • Progressive MBL may be caused by numerous factors related to the implant, the clinician, the patient, the treatment protocol, prosthetic overload, quality of care, and maintenance.
  • It seems like what we see in cases with truly progressive MBL is related to a complicating factor resulting in an immuno-osteolytic reaction accounting for the ongoing bone resorption.

Related: A nuanced view on peri-implantitis – Interview with Tomas Albrektsson

Speaking to Nobel Biocare prior to the consensus meeting, Prof. Albrektsson spoke of the need for dental implant professionals to take a stance against over-reporting of peri-implantitis in the literature:

“I’m increasingly irritated with people calling benign bone loss a disease,” Prof. Albrektsson said. “Those who are doing so have to read the new research that’s out and realize they are wrong.

“And the profession must, in a united manner, protest against alarming reports in a much stronger way than we have done to date. But at the same time we must of course continue to take patients very seriously. We cannot ignore bone loss, even if it proves to be benign. We have to be active all the time and work to the best of our knowledge for our patients.”

The paper is entitled “Peri-implantitis”: A complication of a foreign body or a man-made “disease”. Facts and fiction.

The full reference is: Albrektsson T, Canullo L, Cochran D and De Bruyn H.“Peri-Implantitis”: A Complication of a Foreign Body or a Man-Made “Disease”. Facts and Fiction. Clinical Implant Dentistry and Related Research. doi: 10.1111/cid.12427.  Online Version: May 2016.

 

You can view the abstract in the Wiley online library here.

Press Release
Noble Biocare Newsletter 27.01.2017

by: Michael Stuart