Susceptibility of Peri-implantitis with Dental Implants

Since the inception of an “intra-osseous anchorage for dental prostheses” by PI Brånemark, through landmark trails, screw-shaped implants have become ubiquitous to restore missing teeth (Brånemark et al., Scand J Plast Reconstr Surg 3:81–100, 1969, Adell et al., Scand J Plast Reconstr Surg 4:19–34, 1970, Adell et al., Int J Oral Surg 10:387–416, 1981). Initially, an introduction to dental implants was reserved to trained specialists, and the high success rates have led to their democratization. Education in implantology from 1981 to 2000 mostly focused on training proficient operators to its new technicalities. As the number and time of function of implants increased, an understanding for biological or mechanical successes and complications manifested, especially on the long term after delivery of the implants and restorations. While the technical abilities remain essential, guidelines have appeared on peri-implant health, disease, monitoring, and treatment interventions. Peri-implantitis has been extensively studied since it was introduced at the first European Workshop on Periodontology in 1993 (Berglundh et al., Periodontology 2000, 2024). Its pathogenesis parallels that of periodontitis as peri-implant diseases are defined as a host immune response to a biofilm on the implant surface. It is often forgotten, but because of the immunological nature of the disease, the host is key to its long-term management. In this light, patient compliance and identification of risk factors are paramount to long-term success (Salvi et al., Int J Oral Maxillofac Implants 29(Suppl):292–307, 2014). Peri-implant diseases have been showed not to be symptomatic as most peri-implantitis cases are not symptomatic (Romandini et al., Clin Oral Implants Res 32:100–11, 2021). Therefore, professional monitoring of patients is essential in disease discovery. It will allow to optimize patient education, compliance and early diagnosis of peri-implantitis. It is worth noting that guidelines to maintain health, diagnose, treat disease and monitor long-term outcomes should rely on each single implant in the context of each patient. Considering the latest recommendations in supportive peri-implant care (SPIC) to optimize prevention and treatment of peri-implant diseases is paramount in such a large field of study (Herrera et al., J Clin Periodontol 50(Suppl 26):4–76, 2023). Early diagnosis will permit individualized patient education and stepwise and sensible treatment approaches. It will further strengthen intervention when deemed necessary. Delaying implant placement (DIP) may provide a conceptual framework to time the use of dental implants later in the patient’s life especially in the context of populations with extending lifespans. The objective of this chapter is to provide a clinical guide to the diagnosis and monitoring of peri-implant health, peri-implant mucositis and peri-implantitis and to introduce the concept of delaying implant placement.