On Destructive Peri-implant Bone Loss

Destructive peri-implant bone loss is distressing for both the patient and the treating dentist(s). In severe cases peri-implant bone loss may cause jawbone mutilation, making re-treatment highly complex or impossible and violating the treatment philosophy of “first, do no harm”. There are a multitude of causes of bone loss around a dental implant. These include, but are not limited to, post-operative bone remodeling; the skills or otherwise of the surgeon, the restorative dentist and technicians; patient factors (smoking, bruxing, health and disease of the oral hard and soft tissues, systemic disease); a dis-balanced immunobiological response to the placement of a foreign body; the physical, chemical and topographical properties of the implant; and the response of the commensal bone biofilm populations to the placement of the implant. This paper looks at one possible cause of destructive, peri-implant bone loss and the response of the commensal bone biofilms to the placement of the implant, including the influence that surface topography may have on the behavior of the biofilm populations. A new classification of bone quality and health, based on radiographical anatomy and the associated microbial ecology, is proposed. An aetiology of biofilm-mediated, surface-induced, destructive peri-implant bone loss is described.