Influence of Surgical and Prosthetic Factors on Peri-Implant Health or Disease. Clinical Recommendations From a Spanish Society of Periodontology (SEPA) Expert Consensus

Abstract

Objective: To examine which prosthetic factors, including design, materials, and cleansability, may influence the onset of peri-implant diseases. Materials and Methods: The Spanish Society of Periodontology (SEPA) convened a group of experienced periodontists, prosthodontists, and laboratory technicians to develop clinical recommendations based on expert consensus. Results: Emerging evidence highlights the importance of prosthetic design, implant positioning, and material selection in mitigating biological complications. Notably, access for self-performed oral hygiene is a significant predictor of peri-implant health, and designs that facilitate cleaning and prosthetic configurations that minimize plaque accumulation are favored. Additionally, the use of less porous materials, such as zirconia, has been shown to improve soft tissue integration and plaque control. Other critical considerations include minimizing prosthetic manipulation and ensuring optimal implant-abutment connections to prevent bone loss. Conclusions: This review presents clinical recommendations on prosthetic design, material selection, and implant placement in order to reduce the risk of peri-implant diseases. Future research should focus on refining these strategies and evaluating the long-term effectiveness of digital manufacturing techniques in improving prosthetic accuracy and reducing the incidence of disease. Clinical Significance: Peri-implant diseases, including peri-implantitis, are major concerns in implant dentistry, often linked to suboptimal prosthetic designs and maintenance. This review underscores the importance of prosthetic design in preventing such diseases. Clinicians should prioritize prosthetic configurations that enhance accessibility for self-performed oral hygiene. Furthermore, proper implant positioning in a 3D prosthetically driven position is essential for preventing peri-implant complications. Additionally, the choice of materials, such as ceramic-based and zirconia prostheses, can influence plaque accumulation and soft tissue health. Regular follow-ups and patient education on maintaining good oral hygiene are critical for the prevention of peri-implant diseases. Finally, the increasing use of digital technologies in implant placement and prosthesis manufacturing offers the potential for improving accuracy and minimizing prosthetic misfits, which may further reduce the risk of disease. Future research is needed to explore the impact of digital tools on peri-implant health and to refine best practices in prosthetic design and material selection.