The aim of the review by Salvi and Zitzmann was to systematically appraise whether anti-infective protocols are effective in preventing biologic implant complications and implant loss after a mean observation period of at least 10 years following delivery of the prosthesis.

Out of 15 included studies, only one comparative study assessed the effects of adherence to supportive periodontal therapy (SPT) on the occurrence of biological complications and implant loss.

In view of the lack of randomized trials, observational studies including adherence and lack of adherence to SPT were considered valuable in order to estimate the effects of SPT on implant longevity and the occurrence of biological complications.

• Overall, the outcomes of this systematic review indicated that high long-term survival and success rates of dental implants can be achieved in partially and fully edentulous patients adhering to SPT.
• Long-term implant survival and success rates are lower in patients with a history of periodontal disease adhering to SPT compared with those without a history of periodontal disease.
• The findings of this systematic review indicate that pre-existing peri-implant mucositis in conjunction with lack of adherence to SPT was associated with a higher incidence of peri-implantitis.

Preventive Measures Before Implant Placement

Residual periodontal pockets are a risk for periimplant disease and implant loss. Therefore, completion of active periodontal therapy aiming for elimination of residual pockets with bleeding on probing should precede implant placement in periodontally compromised patients.

• In cases of residual probing depths (PD) ≥ 5 mm with concomitant bleeding on probing, full-mouth plaque scores > 20%, and associated risk factors, retreatment and periodontal reevaluation are recommended before implant placement.
• In subjects diagnosed with aggressive periodontitis, an SPT program with shorter intervals is a prerequisite.
• During implant treatment planning, factors to be considered that may result in biological complications include: insufficient keratinized mucosa and bone volume at the implant recipient site, implant proximity, three-dimensional implant position, and design and cleansability of the prosthesis. Alternative restorative solutions should be considered according to a patient’s individual circumstances.

Preventive Measures After Implant Placement

• All oral health care providers, including undergraduate students, should be trained to recognize clinical signs of peri-implant pathology and maintain or reestablish peri-implant health.
• After delivery of the definitive implant-supported prosthesis, clinical and radiographic baseline measurements should be established.
• During SPT, an update of medical and dental history and a clinical inspection of the implant-supported prosthesis including the evaluation of iatrogenic factors (eg, cement remnants, misfit of prostheses, implant proximity with insufficient access for interproximal oral hygiene) should constitute the basis of a proper diagnostic process.
• Regular diagnostic monitoring of the peri-implant tissues includes assessment of presence of plaque, PD, bleeding on gentle probing (approx 0.25 N), and/or suppuration.
• Changes in PD from a fixed landmark should be assessed regularly and compared to previous examinations.
• In the presence of clinical signs of disease, an appropriate radiograph is indicated in order to detect radiographic bone-level changes compared to previous examinations.
• A diagnosis of peri-implant health is given in the absence of clinical signs of inflammation. A recall frequency of at least once per year is recommended unless systemic and/or local conditions require more frequent intervals. In cases of peri-implant health, professional cleaning including reinforcement of self-performed oral hygiene is recommended as a preventive measure.
• A diagnosis of peri-implant mucositis is given in the presence of individual clinical signs of soft tissue inflammation (eg, redness, edema, suppuration) and bleeding on gentle probing. If mucositis is diagnosed, in addition to reinforcement of selfperformed oral hygiene, mechanical debridement with or without antiseptics (eg, chlorhexidine) is delivered. The use of systemic antibiotics for the treatment of peri-implant mucositis is not justified. Therapy of peri-implant mucositis should be considered as a preventive measure for the onset of peri-implantitis.
• A diagnosis of peri-implantitis is given in the presence of mucositis in conjunction with progressive crestal bone loss. When peri-implantitis is diagnosed, early implementation of appropriate therapy is recommended to prevent further progression of the disease.