No abstract
Replacing missing teeth with titanium dental implants has become a routine procedure. High survival rates, ranging above 95% over a period of 10 years has been reported [
In early 1980s, while talking about the concept of osseointegration, Brånemark distinguished two main reasons of implant loss: poor surgical technique and occlusal overload. Thereafter, the scientists and clinicians highlighted a number of new aetiological factors in peri-implantitis development. Nowadays, we are discussing about multi-factorial aetiology of peri-implantitis i.e. different factors at implant (shape, surface), patient (local and systemic factors), and clinician (competence, new protocols) level. Furthermore, the diagnosis and consequently the evaluation of prevalence of peri-implantitis are too complicated, because there are no unified diagnostic criteria. The natural question then arises: what happened with Brånemark’s osseointegration phenomenon in modern era and why we cannot stop the development of peri-implantitis?
First of all, we should recognize that standard Brånemark “biocompatibility”-oriented protocol seeking for qualitative osseointegration, has been changed dramatically. Nowadays, clinicians are using new protocols to accelerate the treatment procedure - immediate implant placement, immediate loading, or seeking for better aesthetic result - soft tissue grafting, or expanding treatment indications - using different augmentation techniques of the alveolar process. Even a recommended minimal number of dental implants for edentulous jaws rehabilitation were reduced. For example, “all on four” method is recommending only 4 implants in edentulous maxillae. Changes occurred in all fields of implant treatment, including general indications and planning, surgical and prosthetic protocol, timing, and implant material and design. İt is difficult to draw the particular connection between the complications, such as peri-implantitis and innovations, related with method evolution, but one is clear - the new protocols are increasing risk of complications and susceptibility for peri-impantitis development. Furthermore, the number of clinicians performing implant surgery is increasing continuously. Even the dental implant companies are stimulating those processes and young specialists are accepting the challenging cases with enthusiasm and it leads to the increased number of complications.
Some of the authors are highlighting significance of the inflammation due to bacterial load i.e. biofilm and opportunistic infection [
In contrast, huge changes occurred in shapes and materials of the dental implants. Biomedical research is focused on implant geometry and the osteoinductive potential of implant surfaces. In 2009, Junker with co-authors [
How many implant brands do we really need?
Are the regulatory agencies doing their job?
How reliable are experimental data for predicting clinical outcomes?
Does the surface topography really make a difference?
What are the relevant morphological differences between implants?
Nowadays, those questions by Jokstad [
Simion [
In my opinion, we should not turn back, because certainly we are witnessing the dental implant method evolution. However, I would like to take a part in pure science guided evolution, but not Darwin’s wild evolution, where the strongest or fastest will survive. I do not like to check on my patients, which one implant or modification is better, because remember the Hippocratic Oath which begins with the words - “First, do no harm”. Peri-implantitis is “man’s made” disease and this is the reason why we should stop for a moment and try to think about the equilibrium between the pure research and the commercialisation; expanded indications, speed up protocols and loss of confidence either in dental implant method and us. We should feel more responsibility and be more realistic in judgement of the dental implant method evolution, or our patients will judge us.