Influence of Surgical and Prosthetic Factors on Peri-Implant Health: A SEPA Expert Consensus
Peri-implant diseases, including peri-implantitis, represent a major challenge in implant dentistry and are frequently associated with suboptimal prosthetic design and insufficient maintenance. To address this issue, the Spanish Society of Periodontology (SEPA) assembled a panel of experienced periodontists, prosthodontists, and dental lab technicians to evaluate which prosthetic factors — such as implant design, material selection, and cleansability — may influence the development of peri-implant diseases and to formulate clinical recommendations based on expert consensus.
Across these three thematic groups, the strength of evidence for 18 key clinical questions was assessed and clinical recommendations were formulated.
Among other recommendations, the authors suggest:
- The use of tissue-level implants, which have been associated with reduced early marginal bone loss (MBL) compared to bone-level implants. The increased spatial separation supports the establishment of a stable biological width and may limit bone resorption (Hermann et al., 2000). Additionally, the presence of a microgap near the crestal bone in bone-level implants may contribute to MBL through inflammatory responses or mechanical stress concentration (Koutouzis, 2000; Sasada & Cochran, 2017). While most studies report no significant differences in peri-implantitis risk between tissue-level and bone-level implants, some evidence suggests a lower incidence of peri-implantitis in tissue-level implants among patients with a history of periodontitis who are non-compliant with maintenance protocols (Vianna et al., 2018).
- The selection of implants with polished collars for patients at elevated risk of peri-implant disease, since implants with machined collar surfaces have been shown to achieve more favorable outcomes and lower rates of peri-implantitis (Esposito et al., 2014; Vroom et al., 2009).
- The application of platform-switching concepts in restorations located in areas with high esthetic demands, as this approach has been associated with more favorable biological behavior and reduced micromovements under functional loading (Laleman & Lambert, 2023).
- The use of materials such as zirconia, as it has demonstrated advantages with regard to bleeding on probing (Sanz-Martin et al., 2018), reduced biofilm accumulation (Enkling et al., 2022; Sanz-Sanchez et al., 2018), lower levels of inflammation and bacterial colonization (Nascimento et al., 2016; de Oliveira Silva et al., 2020; Clever et al., 2019), and improved mucosal color outcomes, particularly in esthetic regions (Jung et al., 2007).
- Enhancing access for self-performed oral hygiene through selection of implant designs and prosthetic configurations that improve cleansability since it minimizes plaque accumulation (Serino et al. 2009; Monje et al. 2019)
The abstract of the article is available here (>).
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