www.metdental.com
Author Acknowledgements
Patricia A. Miguez, DDS MS PhD
Assistant Professor
Ricardo Walter, DDS MS
Clinical Associate Professor
The University of North Carolina at Chapel Hill
School of Dentistry
Chapel Hill, NC
Drs. Miguez and Walter have no relevant
relationships to disclose.
The following commentary highlights
fundamental and commonly accepted practices
on the subject matter. The information is
intended as a general overview and is for
educational purposes only. This information
does not constitute legal advice, which can only
be provided by an attorney.
© Metropolitan Life Insurance Company,
New York, NY. All materials subject to
this copyright may be photocopied for the
noncommercial purpose of scientific or
educational advancement.
Published May 2017.
Expiration date:
May
2020. The content of this Guide is subject
to change as new scientific information
becomes available.
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ADA CERP is a service of the American Dental
Association to assist dental professionals in
identifying quality providers of continuing dental
education. ADA CERP does not approve or
endorse individual courses or instructors, nor
does it imply acceptance of credit hours by
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Concerns or complaints about a CE provider
may be directed to the provider or to ADA
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Accepted Program Provider FAGD/MAGD
Credit 11/01/16 - 12/31/20.
Address comments to:
dentalquality@MetLife.com
MetLife Dental
Quality Initiatives Program
501 US Highway 22
Bridgewater, NJ 08807
Introduction
Dental implants have been increasingly used for
tooth replacement for several decades.
1
Post-therapy
complications may occur, including both biological and
mechanical failures. Biological complications (peri-implant
mucositis and peri-implantitis) have been often diagnosed
with a poor understanding of the causes or how they
may have been prevented. Though inflammation is often
present around dental implants following placement of a
restoration, studies have shown a ten-year survival rate of
80-100%, dependent upon the presence of risk factors.
2
Peri-implant mucositis is a reversible inflammatory status
of the gingiva and peri-implantitis is characterized by
inflammation of the gingiva with concomitant bone loss.
3
Peri-implantitis has been reported to occur around up
to 47% of restored implants.
3-6
In addition to bacterial
colonization as etiological factor,
6
there are clearly patient
and prosthetic factors contributing to the loss of restored
dental implants.
7
Besides biological problems, the most
common complications reported for implant-borne
restorations have been shown to be screw loosening,
porcelain fracture, loss of retention, and esthetic
concerns.
8
In addition, excess cement has been identified
as a risk indicator for peri-implant diseases with cement-
retained restorations presenting higher prevalence of peri-
implant complications than screw-retained restorations.
9
Quality Resource Guide
Maintenance for Patients with
Implant-Supported Dental Restorations
FIRST EDITION
MetLife designates this activity for
1.0 continuing education credit
for the review of this Quality Resource Guide
and successful completion of the post test.
Educational Objectives
Following this unit of instruction, the practitioner should be able to:
1.
Describe the expected periodontal response that occurs following implant placement and
restoration.
2.
Describe the appropriate steps to maintain dental implants and supported restorations.
3.
Understand the importance of an established maintenance protocol to increase longevity
of dental implants and supported restorations.
4.
Discuss the influence of relevant risk indicators in the maintenance protocol of restored
dental implants.
An expert panel convened by the American College of
Prosthodontists (ACP), American Dental Association
(ADA), Academy of General Dentistry (AGD) and
American Dental Hygienists’ Association (ADHA) critically
reviewed a recently published systematic review
10
on
the topic of maintenance of patients with implant-borne
restorations. This Quality Resource Guide (QRG) is
based on the clinical practice guidelines published by the
expert panel, as well as other literature on the topic of
implant function and complications after placement and
restoration.
11
Tissue Surrounding an
Implant-Supported Restoration
It is important to understand normal and abnormal tissue
presentation around dental implants to properly diagnose
a biological problem. One of the key anatomical findings
of the gingival mucosa around dental implants is that the
collagen fibers do not insert onto the implant neck as
they do to the cementum at the cervical area of a tooth.
This affects the presentation of the soft tissue around
the implant, which is more like mucosa with epithelium
adaptation coronal to a connective tissue band, rather
than a gingival sulcus and junctional epithelium coronal to
a highly cellularized and vascularized connective tissue
attachment to natural teeth. It has been suggested that
the presentation of the connective tissue fibers running