Peri-implant disease

Abstract

For decades, dental implants have provided a seemingly perfect solution for the replacement of diseased or failing human teeth. However, in recent years, reports of peri-implant disease have been increasing and the once-glorified concept of osteointegration as the perfect interface between an inert metal and human bone has crumbled in light of recent findings about reactions of the body against the titanium implant. Smoking and periodontal disease are the most prevalent risk factors for developing peri-implantitis. Other factors contributing to peri-implant disease include diabetes mellitus, antiresorptive therapy, antiangiogenic therapy, and radiation therapy. To this date, there is no generally accepted understanding of the etiology of peri-implant disease, and it is likely that several causes contribute together. In the present chapter, we discuss evidence for the involvement of a number of etiological factors in the pathogenesis of peri-implant disease, including bacterial plaque and contamination, occlusion, surgical technique, cement debris from crown placement, titanium allergies, and foreign body reactions, as well as reactions against titanium particles. Together, these insights shed light on the delicate nature of the titanium/bone interface and question the once-heralded unity of bone and metal as a stable replacement for healthy teeth.