Dental implants are a well-established treatment for edentulism, are now widely available, and are used with ever more frequency. Implant success is largely measured by the aesthetic quality, restored function, and longevity. Risk of failure, most often involving implant loss due to peri-implant infection, is associated with periapical lesions, periodontitis, bone disease, smoking, and alcohol consumption.1-9 Most retrospective (5-year) studies of failed implants show progressive bone loss.10 Longer-term (14-year) studies reveal that peri-implant infection (6.6%), bone loss (7.7%), and bleeding with probing (6.6%) are not rare.11-14
Figure 1. Exposure of implant with the prosthetic abutment placed.
Figure 2. The final prosthetic crown cemented to place, demonstrating an excellent aesthetic result for the patient.
Figure 3. An occlusal view of the prosthetic crown on the implant, demonstrating proper form and anatomy to obtain a functional result.
Figure 4. The prosthetic margin is apical to the IAJ.
Figure 5. Micro-gap of the IAJ is captured and sealed within the cemented dental crown.
A 62-year-old female presented with a missing maxillary right first bicuspid. The tooth was removed due to endodontic complications. The patient did not want the 2 adjacent teeth prepared for a 3-unit bridge. Therefore, the patient made the decision to proceed with a dental implant. A review of the medical history revealed no contra-indications to perform a regeneration procedure and the placement of a dental implant in the edentulous area. A treatment plan was coordinated with the restorative dentist and approved by the patient. A bone regenerative procedure was completed to support a dental implant. There were no complications, and the regenerative procedure healed as anticipated.
Because a dense and diverse population of oral microbes exists in all patients, transient bacteremia may be caused by many dental procedures or even normal daily hygiene routines. The link between periodontal disease and systemic health risks is now well-accepted, therefore a prudent dental professional must consider dental implants as a source of bacteremia caused by peri-implant infection from the IAJ. The micro-gap is not a cleansable location amenable to even the most scrupulous patient or professional care. It may provide a safe harbor for bacteria to thrive, allowing for possible entry into the oral mucosa and bloodstream. As with periodontitis, peri-implant infection may exist without any symptoms, and the inflammatory response may progress unnoticed by patients, even in the presence of an otherwise optimal implantation result. The ferrule design approach seals off this location, which reduces the risks associated with oral infection and optimizes the chances for long-term success with a dental implant. Although the periodontal pathogens are the same for teeth and dental implants, long-term clinical studies will be required to determine whether peri-implantitis constitutes significant risks to systemic health—studies similar to those that have linked periodontal disease and serious systemic health complications. The author’s concern is this: Should the dental profession wait for the systemic problems to occur with implants? Why not take steps to prevent the problem using a dental implant that will prevent the potential risk?
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Disclosure: Dr. Callan is a consultant for PerioSeal and helped design the PerioSeal implant system. He previously served as a consultant to several major dental implant companies.