IMP166 - What Failing Implants Reveal About Peri-implantitis-Article

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The article argues that peri-implantitis is usually not caused by bacteria alone, but by a combination of biological and mechanical factors that “invite” disease. Common contributors include excess residual cement, implant-abutment microgaps and leakage, imperfect component fit, off-axis loading, shallow implant placement, abrupt or convex restoration contours, and uncleanable margins. Connection design matters: conical connections tend to show less microleakage and better stability than internal-hex designs under cyclic load, while repeated flexing can worsen contamination and may release titanium particles.<br /><br />The author stresses that depth and contour are critical. If an implant is placed too close to the crest or restored with an overly abrupt emergence profile, the tissues may remodel apically to create space, increasing bone loss risk. A history of periodontitis also remains an important patient-level risk factor.<br /><br />For diagnosis, clinicians should not label every irritated implant as peri-implantitis. Workup should include baseline radiographs, probing, bleeding/suppuration, recession measurements, and a careful restoration audit. If inflammation is present but bone is stable, the problem may be a prosthetic irritant rather than true peri-implantitis.<br /><br />Treatment depends on salvageability. Mucositis often responds to debridement, improved hygiene, and removal of irritants. True peri-implantitis may require surgery, but decontamination is not reliably predictable. Reconstructive or resective surgery may help when the implant position and defect morphology are favorable. However, if the implant is shallow, malpositioned, uncleanable, or mechanically compromised, explantation may be the most biologically conservative option.<br /><br />Overall, the key message is that prevention begins with smarter planning long before disease appears.

Keywords

peri-implantitis

residual cement

microgaps

implant-abutment leakage

off-axis loading

implant placement depth

emergence profile

periodontitis history

diagnosis

explantation