In this plenary “pre‑implant disease” session, four speakers peeled back the layers of peri‑implant health and disease—from the patient’s individual microbiome and immune makeup, all the way through to cutting‑edge proteomic and animal‑model insights. Here are the key takeaways:
1. “Coffee Machine” Microbiomes Are Uniquely Personal Dup et al. (JDR, 2013) showed that, even within the same mouth, 65% of patients share < 50% of bacterial species between healthy teeth and diseased implants.
Microbiome profiles vary not only person‑to‑person, but site‑to‑site (“top of the machine” vs “bottom”)—making one‑size‑fits‑all diagnostic biomarkers elusive.
2. Proteomics: Finding Disease “Fingerprints” in Peri‑Implant Fluid By analyzing 3,000–4,000 proteins in sulcular fluid, researchers uncovered distinct protein expression clusters that differentiate healthy vs diseased implants.
Such patterns could power future chair‑side assays to spot early disease or guide personalized therapy.
3. Mouse Models Reveal a Unique Immune Imbalance Tobias Fluegge’s team developed micro‑implants in mice to compare peri‑implant vs periodontal sites. They found:
Loss of Langerhans cells (critical epithelial sentinels) around implants.
50–600% influx of neutrophils, monocytes and lymphocytes at implant sites—even under “steady state.”
High RANKL/OPG ratios locally drive bone loss.
Systemic effects: Splenocytes from implanted mice were chronically activated (↑ IFN γ), and contralateral teeth showed immune changes and bone loss—underscoring implants’ far‑reaching immune impact.
4. Antibiotics vs. Immune Modulators Broad‑spectrum antibiotics in mice:
Sterilized oral microbiota, prevented bone loss around teeth…
…but failed to halt bone loss at implant sites, where neutrophils remained elevated.
Resolvin D2 (a pro‑resolving lipid mediator):
Blocked neutrophil influx, dampened inflammation and completely prevented implant bone loss in the mouse peri‑implantitis model.
Points toward immune‑targeted (rather than purely antimicrobial) therapies for more reliable, long‑lasting success.
5. Probiotics: Not Yet a Panacea Meta‑analysis of four RCTs (n≈200 implants) found no significant benefit of oral probiotic supplements on pocket depths or microbial composition in peri‑implantitis or mucositis.
Future directions may include:
Oral‑native strains (e.g. Streptococcus dentisani) rather than gut‑commensal Lactobacilli.
Local delivery (e.g. via healing abutments) to maximize on‑site effects and minimize gut perturbation.
Bottom Line & Future Outlook Microbiome and host‐response are both wildly individualized—like different coffee machines, no two peri‑implant niches are identical.
Current diagnostics and treatments (mechanical debridement, antibiotics, probiotics) often fall short because they neither account for patient‑specific immune differences nor target the chronic inflammation at implant sites.
Next steps point toward:
Proteomic “fingerprinting” to catch early disease and tailor interventions.
Immune‑modulatory agents (e.g. resolvins) to actively resolve rather than merely suppress inflammation.
Personalized implant care, integrating genetic, proteomic and microbiomic data to predict susceptibility and guide both preventive and therapeutic choices.
By embracing this systems‑biology approach—from bench to chairside—implant dentistry can move beyond “one‑size‑fits‑all” protocols toward precision interventions that maintain implant health more predictably.