I have previously written about how little I really know about late dental implant failure caused by the ongoing loss of bone around the dental implant. I just haven’t experienced it or seen it, except in textbooks and articles. So, assuming it does exist as a disease process, can we prevent it and how?

Correct treatment planning and execution (including occlusion) is clearly paramount but, assuming this, the question arises as to how we can look after a successfully placed dental implant to prevent the potential of late failure occurring due to bone breakdown around the implant.

Is there anything we can do and, if so, do we have to do anything? It may be considered that dental implants are more resistant to disease than natural teeth. We have a sulcus of varying depths around the implant abutment, dependent upon how deeply placed the head of the implant is, but we then have attached bone and no periodontal ligament.

Organisms will build up in this sulcus but are they a problem? Is perimucositis a healthy protective response to these organisms and will it inevitably lead to peri-implantitis? On a recall visit for maintenance it is nice to be able to flush around this sulcus (which must not be confused with a periodontal pocket as a healthy implant sulcus can easily be 5mm or more deep) without scratching the abutment, but it is possible we could get away with doing nothing. Perhaps cleaning the sulcus is more important in a periodontally susceptible patient as the periodontal organisms may be implicated in peri-implantitis.

With regards to periodontal (implant) probing, this is likely to be of limited value. Clinical signs and symptoms combined with radiographic examination are more likely to tell us about the actual state of play with regards to dental implant stability and health.

My general opinion is that if it ain’t broke don’t fix it. We have a tendency to over probe and fiddle with healed periodontal tissues, for the sake of doing something, and I feel the same is true for dental implants.

Keep a close eye on the implants with routine checks but accept that often, particularly in patients who have high standards of self-care, things will look after themselves. Perhaps in patients whose homecare is poor, or who have a history of periodontal disease, then we need to do a bit more.

Be selective and more sophisticated in your thinking before you do something. Will what you do cause more damage? Sometimes less is more.

This article has raised, once again, more questions than offered answers. Sometimes we just have to work by instinct alone based on an understanding of the current levels of knowledge.