Microbial challenge in the oral environment may result i pathological reactions in peri-implant tissues and thereby compromise tissue integration. Thus, prevention of disease is a key feature in the aim of preserving supporting tissues around  implants. For the clinician this means that not only appropriate surgical and prosthetic procedures are required, but also sufficient supportive therapy to achieve long-term successful results in implant dentistry, says Professor Tord Berglundh, Department of Periodontology, The Sahlgrenska Academy at theUniversity of Gothenburg, Göteborg, Sweden. This is also the introduction to the manual about supportive therapy in implant dentistry, recently written by Berglundh.

- Successful outcome of implant therapy depends on a number of factors. While surgical technique and biocompatibility of implant components determine healing following implant placement, the long-term success in implant therapy requires preservation of the obtained integration between the implant and the host tissues.

Which are the most important factors for achieving long-term successful results?

– The individual prerequisites of the patient. If a patient has a history of severe problems with for example periodontitis, extra precautions and attention to supportive therapy should be paid. Studies show that these patients are at risk and they suffer from  peri-implantitis to a higher degree than implant patients without a history of periodontitis. The simple explanation is, that what cause periodontitis also cause peri-implantitis, i.e. host response to microbial challenge. It is always of the utmost importance that the patient understands his or her own responsibility when it comes to taking care of their implant-supported restoration, especially in the cases I just mentioned.

– The implant surface is also an important factor. It is the surface characteristics rather than the roughness that is crucial. Some surfaces are more “susceptible” to bacteria than others. I think it is very important that we learn more about different surfaces in order to optimize the biological adaptation also in the long-term.

– The last factor I would like to mention is the prosthetic reconstruction. It  must be as close to natural teeth as possible. From a technical point of view, the possibilities to create crowns on implants have been very flexible compared to creating crowns on existing teeth. An implant reconstruction is replacing both the root and the crown with several components that must interact with each other and also must be compatible with the biological environment. The emergence profile and the position of the crown margin must be considered, as well as the possiblity for the patient to be able to maintain good oral hygiene. The optimal solution is patient-specific abutments based on the final tooth shape.

What is the most important advice dentists should give their implant patients?

– Always emphasize the importance of supportive therapy, and ensure that the patient fully understands that implants require the same attention as natural teeth.

What about the follow-up protocol?

– The patient should get a thorough clinical examination every year. X-rays  are important but should not be used in a routine manner, due to the patient exposure to radiation. I suggest the use of X-ray to establish a baseline, when the crown or bridge is attached and after the first year when the healing process is completed. During the following years  it is only necessary if there are clinical indications, such as bleeding, infection etc.

Is there something that has changed in how you should perform the clinical examination of an implant patient?

– Yes, in the early days of implant dentistry, probing was questioned. We now know that it is one of the most important methods to examine oral health also for implants and not only for natural teeth. There is a strong correlation between the soft- and the hard tissue health so if you want to avoid bone resorption you should pay attention to changes in the soft tissue condition. The healthy soft tissue has an excellent ability to cope with probing and is not damaged if you do it in a correct way. – Under the right circumstances an implant restoration is an excellent solution for tooth replacement, concludes Professor Berglundh.