new EFP guidelines help peri-implant disease treatment

Dental Tribune International

Thu. 13. July 2023

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BRUSSELS, Belgium: The European Federation of Periodontology (EFP) has announced a new guideline aimed at helping oral health professionals around the world to better prevent and treat peri-implant diseases. Based on the latest scientific evidence, the guideline offers a set of recommendations to maintain the health of peri-implant tissue and to effectively manage peri-implant diseases.

This S3 level clinical practice guideline is the outcome of Perio Workshop 2022, a meeting of leading experts and stakeholders that was organised by the EFP last November. S3 level is, according to scientific standards, the highest-quality level of guideline production. After months of work, including a rigorous synthesis of evidence in 13 specially commissioned systematic reviews and a comprehensive consensus process, the paper “Prevention and treatment of peri-implant diseases—the EFP S3 level clinical practice guideline” by Prof. David Herrera and a team of collaborators was published on 4 June in the Journal of Clinical Periodontology.

Prevention of peri-implant diseases should start as soon as dental implants are planned, states the guideline, defining those interventions as primordial prevention. Preventive interventions are also recommended when implants are surgically placed or prosthetically loaded. Once the implants have occlusally loaded, the patient should follow a supportive peri-implant care programme, which should include periodic assessments of peri-implant tissue health and oral hygiene instructions. The popular assumption that maintaining hygiene around dental implants is somehow less demanding than maintaining it around teeth is wrong—in fact, the opposite is true. The good news is that early detection of peri-implant diseases makes treatment easier, faster and more effective.

This guideline follows two similar S3 level clinical practice guidelines that the EFP produced in recent years for modern, evidence-based management of periodontitis. Developed in accordance with the classification of periodontal diseases updated in 2018, these new-generation guidelines were based on the conclusions of Perio Workshop 2019 on the treatment of Stages I–III periodontitis and on those of Perio Workshop 2021 on the treatment of Stage IV periodontitis and were published in 2020 and 2022, respectively.

“Peri-implant diseases are highly prevalent inflammatory conditions and managing them can be quite challenging,” warned Prof. Herrera. “Our guideline provides oral healthcare professionals with advice for effective management of peri-implant diseases. We authors are really proud to present a pioneering guideline informing clinical practices, health systems, policymakers, patients, and the general public, on the most effective modalities available to be implemented during the planning, execution and long-term follow-up of tooth replacement with dental implants.”

Prof. Moritz Kebschull, a co-author of the new guideline, commented: “Following the recommendations will facilitate a consistent, interdisciplinary, and evidence-based approach to the prevention and treatment of peri-implant diseases among all dental professionals.” He added: “The guideline identifies specific interventions demonstrated to be useful, structures them in needs-based care pathways, and examines the current level of scientific support for a variety of widely employed approaches and techniques.”

Understanding peri-implant mucositis and peri-implantitis

There are two peri-implant diseases: peri-implant mucositis and peri-implantitis. Peri-implant mucositis refers to a treatable inflammatory lesion affecting the mucosa around the implant. It is primarily caused by the accumulation of peri-implant biofilm, and smoking, diabetes and radiation therapy are considered risk factors.

If left untreated, peri-implant mucositis may progress to peri-implantitis, causing a progressive loss of supporting bone. Its main risk factors are a history of periodontitis, poor oral hygiene and lack of supportive peri-implant care.

Peri-implant mucositis is sometimes regarded as similar to gingivitis, and the same applies to peri-implantitis and periodontitis. However, compared with periodontal tissue, peri-implant tissue is less efficient in preserving tissue health and controlling the bacterial challenge which is always present around both teeth and dental implants. Thus, when compared with periodontal diseases, peri-implant diseases are more prevalent, develop with an earlier onset and progress faster.