The European Association for Osseointegration's Digital Days recently spotlighted an essential discussion about treating periodontally compromised patients with implants. This session featured Professor Alberto Fonzar, an esteemed Italian periodontist with over three decades of specialization in periodontology, implantology, and prosthodontics.
Understanding Periodontal Compromise and Implant Risks Periodontitis is a significant cause of tooth loss, making the subsequent use of dental implants a common solution. However, as Professor Fonzar highlighted, implants in periodontally compromised patients carry a high risk for biological complications, such as peri-implant infections. These risks are similar to those observed in periodontitis, challenging the previously held belief that implants are immune to infection.
The Evolution of Treatment Insights Professor Fonzar reflected on how the understanding of implant failure has evolved. Initially thought immune to infections, it's now recognized that implants can fail due to peri-implant diseases, which can develop rapidly. This acknowledgment shifts the approach from solely treating the symptoms, such as tooth pockets and decay, to addressing broader patient-related factors like genetics and lifestyle, particularly smoking.
A Case Study in Perspective Highlighting the complexities involved, Professor Fonzar presented a case from 1995 involving a 38-year-old patient with severe aggressive periodontitis. Despite initial treatments focusing on eliminating pockets and tooth decay, the patient eventually lost all her teeth and subsequently her implants due to rapid infection. This case underlines the importance of considering patient-specific factors, such as genetic predisposition and lifestyle habits, which in this instance included smoking more than three packs of cigarettes per day.
Modern Approaches to Treatment The current understanding emphasizes an inflammatory model over the previous infectious model for periodontal disease. This shift recognizes that periodontal and peri-implant diseases primarily stem from an abnormal immune response to oral biofilm. Today's treatments focus more on managing these responses and maintaining rigorous oral hygiene regimes than on aggressive surgical interventions.
When to Opt for Implants Implants should be considered only after thoroughly evaluating the patient's ability to maintain oral hygiene and manage periodontal disease effectively. The decision should balance biological and economic costs and consider the potential need for extensive bone and tissue removal that might come with preserving severely compromised teeth. For Professor Fonzar, the preference leans towards implants when preservation efforts require excessive modification of natural structures.
Key Takeaways The session concluded with a strong reminder of the necessity of comprehensive periodontal treatment prior to implant placement. Continuous maintenance and individualized recall programs are crucial for ensuring the longevity of both implants and natural teeth. The overarching message was clear: successful management of periodontal health is a prerequisite for implant success, and patient education on oral hygiene is paramount.
This discussion not only shed light on the complexities of treating periodontally compromised patients but also reinforced the need for personalized treatment plans that consider both the biological and lifestyle factors influencing periodontal health.