Risk indicators / factors for peri-implant mucositis (4)|palmerah.implantgigi.com

Design of implant‐supported prostheses

Accessibility for biofilm removal around implant‐supported prostheses plays an important role in the prevention and management of peri‐implant diseases. Implants with supramucosal restoration margins yielded significantly greater reductions in probing depths following treatment of peri‐implant mucositis compared with those with submucosal restoration margins. This finding corroborates previous observations on the association between subgingival restoration margins at natural teeth and periodontal inflammation and attachment loss.

Outcomes of a clinical retrospective study indicated that high proportions of implants diagnosed with peri‐implantitis were associated with inadequate biofilm control or lack of accessibility for oral hygiene measures, while peri‐implantitis was rarely detected at implants supporting cleansible prostheses or when proper biofilm control was performed. Consequently, oral hygiene instructions should be individually adapted to patients treated with dental implants because peri‐implant mucositis may be considered a precursor for peri‐implantitis. Furthermore, whenever possible, margins of implant‐supported prostheses should be placed at or above the peri‐implant mucosal margin to facilitate access for biofilm control. Implant‐supported reconstructions impairing access for biofilm removal should be adjusted or replaced by cleansible prostheses.

Dimensions of keratinized peri‐implant mucosa

The effect of the dimensions of peri‐implant keratinized mucosa as a risk indicator for peri‐implant mucositis was investigated in several studies in humans. While some studies reported higher rates of peri‐implant mucositis at implants lacking or surrounded by an inadequate width (<2 mm) of keratinized mucosa, other studies found no association or a postive association. Collectively, evidence for the presence or minimum width of keratinized mucosa around implants to maintain soft tissue health and stability remains controversial. In clinical situations of adequate self‐performed biofilm control around implants, presence or grafting of keratinized mucosa to maintain peri‐implant health does not seem to be essential.

Excess cement

Excess cement has been associated with clinical signs of peri‐implant mucositis. Patients restored with single‐unit crowns with excess cement displayed more signs of peri‐implant mucositis compared with those restored with single‐unit crowns without excess cement. In addition, peri‐implant mucositis was more prevalent in patients with cemented prostheses compared with those with screw‐retained prostheses. Therefore, to avoid cement excess, restoration margins should be located at or above the peri‐implant mucosal margin or restorations should be cemented on individualized abutments allowing proper cement removal.