Prof. Mensi, peri-implantitis is a frequently occurring pathological condition after implant therapy. Is prevention a necessity underestimated by dental professionals in general?
Absolutely! There are too many dentists with different levels of skill placing implants in patients not properly selected or prepared for surgery and without any protocol of maintenance post-surgery. This is a major problem.

Peri-implant diseases have been extensively studied. However, little is known about the true magnitude of the problem, owing to the lack of consistent and definite diagnostic criteria. Why is that, and in your opinion, how can the matter be addressed?
An implant is not a tooth! It is very difficult to use the same parameters we use for the diagnosis of gingivitis and periodontitis. The mucosal tunnel around an implant can be very deep from the beginning. However, it is not a pocket but has an anaerobic environment as a pocket does. Therefore, we can’t use the periodontal probing depth (PPD), clinical attachment level and bleeding on probing (BOP) measurements as we normally do.

The position of the implant at bone level or sub-crestal level is another problem. So we can define mucositis and peri-implantitis as inflammation of the soft tissue with or without bone loss, but we don’t have very clear measurements in terms of pocket depth or bone loss. In general, the literature is very confused and data is not comparable in meta-analyses about the problem.

With the new classification for peri-implant diseases that was presented formally at the EuroPerio9 congress in Amsterdam, clinicians now at least have clearer guidelines. Profuse BOP with a deepening mucosal tunnel is mucositis. If this (or a PPD of more than 6 mm) is connected with more than 3 mm of bone loss, it is peri-implantitis.

How would you describe the role of Guided Biofilm Therapy (GBT) in the treatment of peri-implant disease?
GBT is a really effective way to remove the biofilm on ceramic and resin restorations retained on implants, underneath the implant framework, and on the neck or threads of implants without causing any injury and with instruments that are comfortable for the operator and for the patient. Periodic recall care using the GBT protocol could reduce implant failure or biological complications and could be the first step of the therapy before a surgical approach, when this is needed.

No gold standard for treatment of peri-implantitis has been set to date. For a study published in 2017, you developed the multiple anti-infective non-surgical therapy (MAINST) protocol. Could you please describe how this protocol works, and in your opinion, could it become a standard?
It is a combination of a topical doxycycline-controlled release system and GBT. We treat the acute phase of peri-implantitis just with supragingival biofilm removal with erythritol powder and a subgingival application of a 14% doxycycline gel. After one week, we have a full session of GBT with some local anaesthesia in the site for using the PERIOFLOW nozzle in the pocket on the threads and the PEEK tip to disaggregate calculus if there is any. Then we reapply a dose of antibiotic to increase the effect of GBT and to detoxify the implant surfaces. With a manual curette, we do a gentle curettage of the pocket line to remove the ulcerated epithelium and the granulation tissue. We recall the patient every three months for a full-mouth GBT and control of the implant sites.

This is a very good and effective protocol if combined with a strict home care regimen and control of plaque by the patient and modification of the structures when they are not cleanable.

How important is continuing education in the fight against peri-implantitis?
It is fundamental. We need to stress the importance of prevention, interceptive therapy and maintenance. We need to educate dentists and dental technicians in creating cleanable prostheses and selecting or treating patients before surgery. We need to educate dental hygienists in using new technologies and supplements to fight this problem.

As part of the 24-hour webinar, which will be hosted by EMS and the Swiss Dental Academy and broadcast live starting on 23 November at 1 p.m. CET, Mensi will be holding a 1-hour lecture titled “Implants and prevention: Clinical experience and success”. Her presentation is scheduled to start on 24 November at 11 a.m. CET. During the English-language webinar, she will be showing different tools and protocols for biofilm removal from implant surfaces, giving an overview about the current research on non-surgical treatment of peri-implant diseases, and explaining the GBT and MAINST protocols, illustrating these with clinical cases. Attendance of the webinar is free of charge. Dental professionals interested in attending the online webinar can find more information and may register at www.24hdentalwebinar.com.

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