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Prevention and management of biological complications

Video highlights

  • Impact of complications on clinical efficiency and everyday practice
  • Implant health and the ideal hard and soft tissue environment
  • The role of roughness and cleanliness of the implant surface
  • How to diagnose and evaluate risk of biological complications
  • Surgical, prosthetic and treatment approaches to prevent peri-implant disease
  • How to manage the hard and soft tissues respecting biology
  • Implant maintenance and clinical management of peri-implant disease


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asked by Emil Svoboda

Subgingival cement was mentioned as a risk factor for disease .... Why not implant-abutment misfit?

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What makes a joint more stable and resistant to infection...  fit or misfit? The literature is clear about the relationship of misfit with the screw-in technique and Jempt’s study shows prosthetics retained by 4 or more retainers had 15X the rate of peri-implantitis than those retained by 3 or less retainers. Please comment on this.  Thank you.
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Re: Why not implant-abutment misfit?  There is according to my understanding a short answer to this question; yes, why not! I listed some few years ago about 85 different variables that have been discussed in relation to inflammation, bone loss and implant failures (Jemt, Int J Prosthodont 2018).  However – if “yes” – it is not the one and only variable! / Posted by the administrator on behalf or T. Jemt
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Re: What makes a joint more stable and resistant to infection?  According to my knowledge there is no clinical evidence that there are “joints” which are more or less “resistant to infection” and if the “joints” should have any significant impact on the implant failure pattern.  Probably every implant prosthesis supported by more than one implant present a “misfit” – if not –  it would be impossible to prove “passive fit” in the clinic.  I feel that it would be extremely difficult to establish a statistical causal relationship between “joints”, “infection” and implant failures. Posted by the administrator on behalf of Torsten Jemt. 
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Re: 4 or more vs. 3 or fewer retainers: For me, numbers of implants may not only be associated to “misfit” but numbers of implants may also be associated to different clinical conditions associated with different risk patterns in different patients (Jemt, Clin Impl Dent Res. 2020). Thus, patients with single implants present a lower risk for failures than patients treated in the edentulous jaw probably because of many different reasons, and this can be observed even though abutments have repeatedly been reconnected several times in the single implant condition as compared the edentulous patients (another suggested variable; Jemt IJP 2018). Please, notice also that in the analyses of edentulous patients there seems to be no linear relationship between numbers of implants and implant failures – instead there seems to be a “U-shaped” risk pattern with a higher risk of failures for those patients provided with few and many implants in the edentulous jaw (Jemt & Lekholm, JOMI 1995; Jemt, Int J Prosthodont 2018). Posted by the administrator on behalf of Torsten Jemt 
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Re: Peri-implantitis... I try to not use the condition “peri-implantitis” in my studies because there are so many different definitions and because there are two major questions that the dental community must sort out first. One question is related to bone loss after tooth removal – we know that bone beneath dentures and pontics resorbs. The question is – should we expect that implants prevent further bone loss in edentulous areas after placement? There is no clinical evidence that this is the case – so we cannot refer bone loss at implants as a “disease” because we don’t know if bone may/should/must continue to resorb or not after placement of the implant. The second question is whether we see the implant as “a tooth” or as a “foreign body”. If we see implants from a biological point of view as “a tooth” – then we could expect a condition at the implant as “healthy” when there is no inflammation. On the other hand, if the implant is a “foreign body” we must expect an inflammatory response from the immune system – probably for the rest of the life of the implant/patient. If that would be the case – no inflammatory response at all would then be a “disease”.  This is a much more difficult way to discuss the conditions at implants and many avoid this and chose the easy way (“a tooth”). There is a very unclear relationship between “peri-implantitis” and future implant failures - dental scientists have no consensus on these two questions discussed above. / Torsten Jemt