Biological complications with dental implants: their prevention, diagnosisand treatment

Biofilms form on all hard non-shedding surfaces in a fluid system, i.e. bot h on teeth and oral implants. As a result of the bacterial challenge, the h ost responds by mounting a defence mechanism leading to inflammation of the soft tissues. In the dento-gingival unit, this results in the well-describ ed lesion of gingivitis. In the implanto-mucosal unit, this inflammation is termed "mucositis". If plaque is allowed to accumulate for prolonged perio ds of time, experimental research has demonstrated that "mucositis" may dev elop into "periimplantitis" affecting the periimplant supporting bone circu mferentially. Although the bony support may be lost coronally, the implant still remains osseointegrated and hence, clinically stable. This is the rea son why mobility represents an insensitive, but specific diagnostic feature of "periimplantitis". More sensitive and more reliable parameters of devel oping and existing periimplant infections are "bleeding on probing", "probi ng depths" and radiographic interpretation of conventional or subtraction r adiographs. Depending on the diagnosis made continuously during recall visi ts, a maintenance system termed Cummulative Interceptive Supportive Therapy (CIST) has been proposed.