Implant Related Risk Factors

While peri-implant diseases are attributable to bacterial colonization, the implant microroughness surface may serve as a viable niche to collect and promote putative micro-organisms. It is nowadays understood that preventing/minimizing physiologic bone loss as consequence of surgical trauma or the establishment of the supra-crestal connective tissue attachment is key to maintain long-term stability. In general, if initial bone loss exceeds beyond ~0.5 mm, the odds to manifest peri-implant complications and implant failure down the road are significantly higher. It is speculated, thus, that the exposure of the implant surface to the peri-implant sulcus due to bone loss leads to inflammation mediated by the formation of bacterial colonies in the implant surface. Therefore, in the spirit of preventing biological complications, it is critical to identify and apply the surgical and prosthetic factors that may assist in limiting early bone remodeling.⁸

The type of implant can also effect the prevalence of peri-implant disease. Cemented implants can be a potential risk factor if cement is not completely removed. The remaining cement can foster the attachment of plaque bacteria leading to inflammation. As long as excess cement is removed properly, cement implants are not more likely to have peri-implant disease when compared to screw retained implants. Therefore, in order to maximize the prevention of peri-implant diseases, dental professionals need to thoroughly remove excess cement to prevent the possibility of inflammation. Other plaque retaining factors should be eliminated as well.^8,10

Figure 6: Cement excess visible on radiograph.

Figure 6: Cement excess visible on radiograph.