Recent studies report that more than 35 million Americans miss all their teeth, and almost 180 million are missing at least one tooth. The projections of these numbers are expected to grow in the next twenty years.

Over the past decades, the use of dental implants to replace missing teeth has been considered the standard long-term treatment alternative in different situations due to its high success rate. Through the years, the validity of this treatment option has been investigated and confir


The posterior sextant were treated to restore the missing dentition and improve patient’s quality of life.

med by several long-term studies.



Rehabilitation of partially edentulous patient with dental implant before (A) and after (B).


An insight in the future shows that implants are becoming the treatment of choice for more edentulous patients if compared to 25 years ago. Implant improved quality and newer technologies of use, improved patient’s’ lifestyle and request for a more permanent solution than complete dentures, increase esthetic expectation, increased success rate for implants and diffuse knowledge on their existence, are some of examples. Advancements in implant designs, bone grafting procedures, and analysis of extensive outcome data have greatly narrowed the range of absolute contraindications for implant therapy. Also, more dental insurance companies are covering some parts of implant treatment and patients are more likely this option.

Despite the promising and shining future of implant therapy, there is also the other side of the coin: the peri-implant disease. This term includes two categories: peri-implant mucositis and peri-implantitis. The common trait of these two scenarios is the inflammation of the tissues surrounding the implant with bone loss only occurring in peri-implantitis. Generally speaking they can be seen as the gingivitis and periodontitis that affect teeth. Most of the time, peri-implant disease is “silent” and only a visit to the dentist or periodontist can identify it. Peri-implant mucositis can be very mild and determine only bleeding and gum redness.  In some other cases, the patient can experience acute pain, pus discharge with “bad taste in the mouth”, severe bleeding and mobility of the implant. There are different grades and stages of this disease. Some cases can be identified early and treated, while others are deemed to fail ending with implant removal.

Patient affected with peri-implantitis on her central implant restoration. Deep probing and Bleeding. Fig. 2A. Radiograph showing bone loss (arrows).

Patient affected with peri-implantitis on her central implant restoration. Deep probing and Bleeding. Fig. 2A.
Radiograph showing bone loss (arrows).

Fig. 2 B Implant was deemed not treatable and explanted.

Fig. 2 B
Implant was deemed not treatable and explanted.


Peri-implant disease is a serious reality that affects the present and the future of dentistry.  It is a global burden that is present on up to 47% of implant patients and it constitutes one of the major challenges in modern implant dentistry, where primary prevention holds all the endeavors.

With the increasing number of implant that are placed everyday, the frequency of peri-implant disease has greatly expanded. However, still many questions need an answer regarding its true cause and features. No official diagnostic criteria and classification of the disease have been introduced yet. Many factors contribute to the disease appearance and manifestation but there is no agreement on which one is the predominant. Systemic condition of the patient (diabetes), calculus deposit, crown cement deposit, smoking, lack of oral hygiene and maintenance are all contributing to appearance of peri-implant disease. The other bad news is that there is not a commonly accepted treatment for it.

On the other hand, the good news is that the patient can maintaining the implant free of plaque and keep the inflammation away. Routine visit to the dentist can identify and treat this disease on time. In fact, some cases can be treated with a simple professional debridement sessions. It is important that the patient is constantly trained and instructed on how to maintain the area.

In conclusion, while dental implants are an important tool to help to improve patient oral health and life, they have to be treated and maintained in the proper way. The baseline is patient understanding and ability on oral hygiene maneuvers. Second, it is very important to respect a meticulous and regular professional maintenance schedule with the dental hygienist or periodontist. Regular investigations on Pocket depth and follow up radiographs are paramount.

– Dr. Lorenzo Mordini

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