Clinical Decision Making for Treatment of Patients with Peri-implant Diseases

Complications affecting implants are common and of concern for patients and practitioners alike. Proper maintenance of implants to insure health as well as identification and treatment of prosthetic and biologic complications is critical to the long-term function, esthetics, phonetics, and health of patients who have received endosseous dental implants for tooth replacement. It has been a great challenge of clinicians to properly manage and treat peri-implant disease. The decision tree presented here (Figure 5) was fabricated to guide treatment of these diseases and to possibly intervene at an earlier time point. This particular assessment emphasizes ongoing monitoring of implant health as a part of supportive peri-implant therapy and early detection of peri-implant disease. When treating peri-implant conditions, it is critically important to recognize peri-implant disease at the earliest stage of disease to start treatment immediately to reduce clinical signs of inflammation and progressive attachment loss. If peri-implant disease is identified, clinical decisions for nonsurgical and surgical intervention to treat that disease must be undertaken in a systematic manner. Because evidence suggests that traditional nonsurgical therapy alone is inadequate to treat peri-implantitis, use of adjunctive methods for implant surface decontamination should be considered by the clinician when appropriate. The decision tree in Figure 5 may help guide the management of clinical complications with implant therapy, such as peri-implant mucositis, peri-implantitis, and loss of osseointegration.

Figure 4. Decision matrix for peri-implant conditions.

Figure 4. Decision matrix for peri-implant conditions.