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Tue. 14. February 2023

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The digital revolution continues. Like all areas of dentistry, implantology is going digital. The potential benefits of a digital workflow can be applied to various stages in the treatment journey, often improving outcomes, as well as both the patient and professional experience.

We are seeing an increase in the use of intra-oral scanners, which can acquire highly accurate impressions while improving patient comfort compared to conventional alginate methods. For the clinical team, digital scans can be easily integrated within the wider digital workflow and facilitate prosthetic design, as well as streamlining communication and collaboration with colleagues. I would estimate that around 20–30% of clinicians in the UK now own and utilise these scanners, but I would expect this to increase in the next couple of years as the technology improves and becomes even more accessible.

CBCT is the other digital solution supporting dental implantology today. These scans have become central to precise and confident treatment planning, allowing clinicians to determine the ideal position, angle, depth and width of dental implant in every single case. This, combined with prosthetically-driven planning protocols, ensures that any dental implant placed can be restored correctly for good function, aesthetics, maintenance and longevity.

Attitudes to metal in the mouth

Another trend we are seeing in the UK is an increase in a patient-driven move away from metal. While certainly not yet the norm, my colleagues and I are receiving more enquires about and requests for metal-free alternatives to conventional dental implants. This echoes some of the changes already seen across other sectors such as restorative dentistry and creates an interesting dynamic for the future. Ceramic implants are available for clinicians to utilise―backed by science and proven to deliver good clinical results―and these are now being employed more regularly than they were just a few years ago.

Yet to come

There are some interesting technologies currently being introduced and in development that could have a positive impact on dental implantology in the future. For example, there is navigation software that allows the clinician to prepare the dental implant site while using the CBCT scan in real time as a kind of virtual guide. It offers an alternative way to provide guided surgery, allowing for a free-hand approach that makes use of digital technology for more accurate and confident dental implant placement. This kind of technology is still quite new to the field, but it is likely to become a more popular technique as the software evolves.

The other area in which changes are afoot, is the management of peri-implantitis. Prevalence is difficult to measure, but according to current research, it occurs in 12.5–19.5% of cases at patient-level and implant-level, respectively.1 A leading cause of dental implant complications, it remains a disease that is not fully understood by the profession or by patients. Prof. Niklaus Lang from the Queen Mary University of London once said at a conference I attended: “Periodontitis was made by God, peri-implantitis was made by man.” This illustrates the difference between the two diseases, and we must develop management techniques that take this into consideration. As a specialist periodontist, this is a topic I feel passionate about, and the Association of Dental Implantology has long recognised as an important area for the progression of the field. We have held events dedicated to discussing the challenges of peri-implantitis and exploring potential solutions for this very reason.

“It is an exciting time to be involved with the dental implant field and to utilise many new innovations as they reach the market.”

For the future, how we clean dental implants will likely be further scrutinised. There is already technology available for electrolytic cleaning of the dental implant surface, which has been shown to inactivate bacterial biofilm far better than using a powder-spray system.2 Given the spotlight on prevention of bacterial infection in the UK dental implant field, effective new ways of cleaning the products that we use would be widely welcomed.

Of course, this will be in addition to―or perhaps even second to―prevention of the disease in the first place. We know the risk factors for peri-implantitis, but if we can hone in on the exact mechanisms behind development, then we could change the game entirely for many patients. With more research, a greater understanding of the disease and the next generation of technology and materials, we will be even better equipped to stop peri-implantitis before it becomes a problem.

Aside from these, there will no doubt be a shift in some of the other clinical techniques and products employed as part of the dental implant workflow in the near future. For example, socket shielding is being brought to the fore at professional events and conferences, and novel dental implant designs are being worked on to help further minimise potential complications. It is an exciting time to be involved with the dental implant field and to utilise many new innovations as they reach the market. Concentrating on science-backed and evidence-based solutions remains crucial, but we can expect to deliver ever-better dental implant treatment to patients in the years to come.

Editorial note:

References

  1. Diaz, P., Gonzalo, E., Villagra, L.J.G. et al. What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health 22, 449 (2022).
  2. Ratka C, Weigl P, Henrich D, Koch F, Schlee M, Zipprich H. The Effect of In Vitro Electrolytic Cleaning on Biofilm-Contaminated Implant Surfaces. J Clin Med. 2019 Sep 6;8(9):1397. Erratum in: J Clin Med. 2022 Feb 08;11(3): PMID: 31500093; PMCID: PMC6780638.

CBCT Dental biofilm Dental implantology Digital workflows in dentistry International Dental Show Intraoral scanner Metal-free implantology

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