Emerging Paradigms and Strategies for Long-Lasting Peri-implant Tissue Health

Dental Implants are no longer perceived as metal constructions passively anchored in bone. On the contrary, implants are shown to be biologically active systems, which constantly interact with human tissue and microbes, supporting function and aesthetics in a delicate balance between biology and technology. It is exactly this interrelation between living tissue and precisely constructed biomaterials that determines long term success or complications. In no other part is this interrelation more crucial than within the Supracrestal Complex.

Possibly one of the most complex man-made ecosystems, the Supracrestal Complex is the tiny space defined by the cortical Marginal Bone (apically) and the first couple of mm of the implant prosthesis exposed in the oral environment (coronally). It’s no more than 200 square mm, but this tiny space packs 3 out of the 4 tissues of the human body, at least 3 mechanical constructions (implant, abutment, abutment screw, prosthesis), more than 300 types of human cells and countless numbers of bacterial species.

The Supracrestal Complex is a true “cyborg” organ: it includes all 3 key players: Human Tissue, Mechanical parts and Bacteria in a constant dynamic interplay. As recent studies have pointed out, this tiny space is the source of the most common implant long-term complications of both the biological and the technical type. Proper design coupled with a careful, individualized maintenance scheme and daily practice of oral hygiene from the patient are the keys to ensure long term successful clinical outcomes!

In this presentation, we will identify the interactions that take place in the Supracrestal Complex, we will discuss the latest evidence of design features and conditions that give rise to the most common problems and finally identify the strategies for prevention or early identification of Mucositis and Peri-implantitis.

Learning Objectives

- What is the Implant Supracrestal complex and what are the key elements and design features with clinical importance

- How the design of the Implant-prosthesis -abutment complex can predispose to or protect from biological complications and peri-implant tissue inflammation

- How can we devise individualized maintenance strategies and use professional and patient driven maintenance to ensure long term success and health of the peri-implant tissues