Periodontally Considerations of Dental Implantology

Author(s):

Lee H. Silverstein, DDS, MS, FACD, FICD;Jerry J. Garnick , David Kurtzman, DDS, Peter C. Shatz

Date Added:

1/1/1998

The endosseous dental implant has steadily progressed to become an important modality of restoring incomplete dentitions in either fully or partially edentulous patients. Osseointegrated dental implants have demonstrated relatively high success rates in both the maxillary and the mandibular jaws. The American Academy of Implant Dentistry (AAID), the American Dental Association (ADA), and numerous other professional organizations have endorsed the placement of osseointegrated dental implants as a viable and predictable treatment modality.

Inclusion of the placement, restoration, and maintenance of dental implants is an important part of the newly defined responsibilities of general dental practitioners, prosthodontists, periodontists, and oral surgeons. Recently, postdoctoral periodontics training requirements have been modified to include mandatory teaching of the diagnosis, treatment planning, placement, and maintenance of osseointegrated dental implants in all graduate periodontics residency programs.

The critical prerequisite for successful endosseous- type dental implants, in addition to their being osseointegrated, is the achievement of perimucosal seals of the various soft tissue layers adjacent to the implant surface. The presence of an adequate zone of attached keratinized peri-implant gingiva may be essential for (1) maintenance of peri-implant health, (2) prevention of gingival recession, and (3) establishment of stable levels of the connective tissue and alveolar bony attachments. Failure to obtain or maintain this perimucosal seal may result in loss of connective tissue adhesion. This results in apical migration of the epithelium into the alveolar bone-implant surface, which ultimately results in a soft -tissue encapsulation of the endosseous portion of the dental implant. This connective tissue encapSUlation will eventually cause the failure of the dental implant.

Subsequent to exhaustive evaluations of most implant systems, the consensus has been that there is currently no single "ideal" implant design. Implants of different designs, shapes, widths, and heights are necessary to overcome the limitations imposed by inadequate residual bone morphology and density.