“Understanding patterns of peri-implant bacterial colonisation is fundamental to preventing progression to peri-implant mucositis”

Why is understanding bacterial colonisation so important for the long-term health of dental implants?
Understanding patterns of peri-implant bacterial colonisation is fundamental to preventing progression to peri-implant mucositis or, more seriously, peri-implantitis of varying severity and to managing the consequences if progression does occur. Through our studies and a critical analysis of the literature, we have been able to distinguish different patterns of peri-implant disease and establish management protocols. We have observed that, in around 70% of cases, peri-implant disease is bacterial in origin and begins at the implant’s transmucosal collar.

Do titanium and zirconia interact differently with soft tissue, and how does this affect bacterial growth or the risk of peri-implant inflammation?
Yes. The use of hybrid implants with zirconia collars has given us a clinical advantage in managing the risk of peri-implant disease. We have shown that zirconia can support epithelial attachment through hemidesmosome-associated structures, contributing to the formation of a stronger peri-implant mucosal seal in addition to the well-established process of osseointegration.

This soft-tissue integration creates an additional biological seal that is not achieved to the same extent with conventional implants. It provides protection at the implant’s transmucosal collar, the component most exposed to bacterial challenge.

” Decisions about the most appropriate therapeutic approach should be based on robust scientific evidence.”

Given the alarming rates of peri-implant mucositis and peri-implantitis, what preventive strategies do you consider most critical for everyday practice?
Today, one of the most significant challenges in implantology concerns the aesthetic zone. In the posterior region, the dentist often has more room for compromise and can restore implants with fewer aesthetic limitations. In the aesthetic zone, however, any complication can create a significant aesthetic problem that is difficult to manage surgically.

Medium- and long-term predictability and tissue stability are essential to giving clinicians confidence when approaching rehabilitation in the anterior region. This remains a complex challenge, especially in cases involving hard- and/or soft-tissue deficiencies around a single implant adjacent to healthy natural teeth.

In everyday practice, prevention therefore begins with careful case selection, optimal implant positioning, respect for the soft-tissue phenotype and the creation of a stable emergence profile. Over time, clinicians have had to develop increasingly advanced prosthetic skills to compensate for a lack of keratinised gingiva or to manage tissue deficiencies caused by implant placement outside the ideal biological and prosthetic parameters. Even peri-implant reconstructive techniques and procedures to treat horizontal bone defects, such as distraction osteogenesis, have not always guaranteed the desired outcome.

As patients’ aesthetic expectations and demands have increased, partly owing to the influence of the internet and health-related forums, the use of reconstructive techniques and related biomaterials has also grown in recent years. However, this has not necessarily made therapeutic protocols easier to perform. Predictable and reproducible outcomes often remain limited to experienced clinicians with a strong surgical background, as these techniques require substantial time and effort to learn.

The use of hybrid implants with a 1.5 mm zirconia collar has made it possible to address tissue defects in the aesthetic zone by providing a scaffold that supports the overlying connective tissue and helps prevent retraction over time, thereby supporting soft-tissue regeneration. This can help support the soft-tissue contour horizontally and allow for highly predictable vertical soft-tissue stability. These characteristics have been observed over time with zirconia-based prosthetic solutions, which appear to have beneficial effects in reducing bacterial accumulation and improving soft-tissue quality and stability.

What do you hope your research will ultimately change in implant design or strategies for preventing peri-implant disease?
I hope that our studies will encourage clinicians to make more informed choices about the tools and materials they use in oral rehabilitation. Decisions about the most appropriate therapeutic approach should be based on robust scientific evidence.

In dentistry, current trends can sometimes negatively influence the choices made by oral surgeons and may cause them to overlook important aspects such as predictability and soft-tissue stability after implant placement and restoration. These are fundamental to the long-term success of implant rehabilitation.