The challenges of managing peri-implantitis

on 1st November 2018

Ahead of November’s Association of Dental Implantology event, Rana Al-Falaki discusses the challenges of managing peri-implantitis

Peri-implantitis is a common issue faced in implant dentistry today. It is a challenging condition to predict, prevent and treat, as it is still not completely understood.

I have a particular interest in the disease, and have been conducting research into the applications of lasers in periodontology and implant dentistry.

Peri-implantitis is becoming the epidemic of dentistry, and the biggest problem is that there is no gold standard way of treating it that guarantees long-term success. The idea of ‘implants for life’ is sadly being disproven. Patients pay substantial amounts of money to have implants placed, so when they start to fail this has a significant psychological impact. The cost of treatment is high, and the cost of replacing a failed dental implant (if it’s even clinically possible) is even higher.

One of the surprising challenges of managing peri-implantitis is the actual diagnosis, and it’s an area that is poorly understood. Confidence to probe around dental implants to aid diagnosis has been a big issue in the past, but we’re getting better at that. However, it’s almost a case of ‘oh dear – there’s bleeding around the implant – now what do I do?!’, and it may get left for another six months.

This disease process cannot be left for that long – it progresses so rapidly and the longer it is left, the more complicated and less predictable possible treatment outcomes become.

The aetiology is complex, so the decision tree for management is not, in the slightest bit, straightforward. It usually involves the need for surgery, which most are not confident in performing.

Treatment options

In terms of current management concepts available for peri-implantitis, treatment with laser technology seems beneficial.

Treatment of peri-implantitis aims to manage the active disease process, while also trying to address the aetiological factors. In most cases, there is a need for surgical treatment, which may just be for access and decontamination. This might include bone grafting, altering morphology to improve access for oral hygiene, and/or soft tissue work such as grafting to increase the zone of keratinised tissue and vestibular releases to limit mobility.

Lasers can help in all of these steps (depending on the type of laser), and so far the research is very promising as to the effectiveness lasers have in decontaminating and cleaning the dental implant surfaces, as well as restoring biocompatibility – which is your gold standard ideal outcome. More attractive still is the ability in most cases to be able to treat peri-implantitis with a flapless approach in mild to moderate cases, which requires less time and less expense. This also helps to achieve better aesthetics and causes far less morbidity for our patients, offering an easier and less stressful procedure for the clinician. That’s just a few of the advantages.

Gaining insight

I will be addressing this topic at the Association of Dental Implantology (ADI) Focus Meeting on 17 November in Birmingham. Organised by the ADI, it presents the perfect opportunity for professionals to update and develop their knowledge in the field of dental implants.

In my presentation entitled ‘Light at the end of the tunnel: are lasers the answer to peri-implantitis?’, I will explore the current classifications for the disease and describe possible treatment protocols using flapless laser techniques.

Delegates will gain insight into the effective use of erbium lasers and better understand when regeneration, implantoplasty or explantation are indicated. The session will also cover how to create an effective maintenance programme that encourages longer-term stability of dental implants.

Of course, there’s only so much I can cover in a 45-minute lecture, but I want to get across a thorough understanding of the current management concepts to enhance successful treatment. Lasers are one tool in the armamentarium, but different lasers work in different ways, and it’s not a case of ‘one size fits all’. It is also a poorly understood area given that it’s still so new, so the research base is not yet vast.

I would like delegates to leave a bit more hopeful that something is showing promise in treating their cases more easily and successfully.

I hope this will inspire them to either treat peri-implantitis themselves, or to be more confident about cases they refer and what they advise their patients. 

The ADI Focus Meeting takes place on 17 November at ICC Birmingham. For more details, visit here.


About the author

Rana Al-Falaki is a specialist periodontist with a particular interest in peri-implantitis. She is an undergraduate and postgraduate clinical lecturer and consultant as well as a Fellow of the International Academy of Dento-Facial Esthetics, an honorary lecturer at King’s College Dental School, University of London and a visiting professor to the Medical University of Taipei.

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