Contemporary oral health strategies: from tooth preservation to long-term peri-implant care

Topic: The aim of this presentation is to provide a comprehensive overview of decontamination techniques utilized in the surgical management of peri-implantitis, with a specific focus on the electrolytic decontamination method. A session co-organized by Straumann and Procter&Gamble.

Digest 

Setting the stage: collaboration and the challenge of peri-implant diseases

The comprehensive presentation opens with a powerful case study from Professor France Lambert, highlighting the clinical and emotional weight of peri-implant diseases. The forum, a collaboration between Procter & Gamble Oral-B and the Straumann Group, brings together global experts to address a central question: how can we preserve teeth—and implants—for life? Lambert emphasizes that even with optimal treatment of periodontitis and proper implant placement, long-term maintenance is often compromised without ongoing care, especially in patients with risk factors like poor hygiene and smoking. This sets the tone for a deeper discussion on prevention, diagnosis, and intervention for peri-implant mucositis and peri-implantitis.

The critical importance of infection control in periodontal care is then explored. Using case studies and epidemiological data, it is argued that preserving natural teeth is almost always preferable to early implant placement, particularly for patients with a history of periodontitis. It is underscored that such individuals are at significantly higher risk for peri-implantitis, a fact supported by multiple data sets. The concept of time-efficient is introduced, nonsurgical periodontal therapy that combines patient-driven plaque control with minimal professional instrumentation, demonstrating its efficacy through recent large-scale Swedish studies. Systemic implications of periodontal disease are also touched, particularly its impact on diabetes-related complications, reinforcing the medical importance of oral health.

Innovations in decontamination and reconstructive strategies

Dr. Lucrezia Paterno-Holtzman delves into the clinical challenges of managing peri-implantitis, especially when choosing between implant preservation and explantation. She highlights the psychological, functional, and economic benefits of saving implants when possible, while cautioning that treatment must be case-specific. Her presentation focuses on various surgical and nonsurgical approaches, including mechanical debridement, prosthetic redesign for better hygiene access, and soft tissue grafting using Straumann(r) Regenerative Solutions. She outlines real-life cases demonstrating access flap procedures and reconstructive treatments, often enhanced by autologous grafts to improve mucosal stability and keratinized tissue width.

A major innovation discussed is electrolytic decontamination, a method showing promising results in in vitro and in vivo studies. This approach, which generates hydrogen peroxide to lift and neutralize biofilm, is noted for being gentle on titanium surfaces and possibly enhancing their biocompatibility. While more clinical data is needed, early trials suggest this technique may outperform conventional mechanical or chemical debridement, particularly in hard-to-reach areas. Dr. Paterno emphasizes the importance of case selection, long-term monitoring, and tailored maintenance plans to ensure success. Both speakers conclude with a broader reflection on the role of oral health in systemic wellness, advocating for its integration into mainstream medical care.

Key takeaways for modern implantology and periodontal care:

• Prevention of peri-implant disease begins well before implant placement and continues indefinitely through regular care.
• A history of periodontitis is a strong risk factor for implant complications; preserving teeth is often the best option.
• New technologies like the electrolytic cleaning with Straumann(r) GalvoSurge offer promising, non-invasive methods to improve implant decontamination and long-term outcomes.