Clinical Decision Making for Treatment of Patients with Peri-implant Diseases

Complications affecting implants are common and of concern for patients and practitioners alike. Proper maintenance of implants to insure health as well as identification and treatment of prosthetic and biologic complications is critical to the long-term function, esthetics, phonetics, and health of patients who have received endosseous dental implants for tooth replacement. It has been a great challenge of clinicians to properly manage and treat peri-implant disease. The decision tree presented here (Figure 5) was fabricated to guide treatment of these diseases and to possibly intervene at an earlier time point. It was found that other decision trees and case reports in the literature had shortcomings of starting their initial treatment at later steps of the disease process, like mobility. The goal of this course is to stress the importance of recognizing peri-implant disease at the earlier “ailing” phases and to start treatment immediately. Another goal is to outline clinical decisions for surgical intervention of “failing” implants. The decision tree in Figure 5 may help guide the management of clinical complications with implant therapy, such as peri-implant mucositis, peri-implantitis, and complete failure.

Figure 5. Decision matrix for peri-implant conditions.
Decision matrix for peri-implant conditions.