PERI-IMPLANTITIS is a common issue faced in the field of dental implantology today. It is a challenging condition to predict, prevent and treat as it is still not completely understood, Dr Rana Al-Falaki is a Specialist Periodontist with a particular interest in the disease.
An undergraduate and postgraduate clinical lecturer and consultant, Dr Al-Falaki is conducting her own research into the applications of lasers in periodontology and dental implantology.
A Fellow of the International Academy of Dento-Facial Esthetics, an honorary lecturer at King’s College Dental School, University of London and a visiting professor to the Medical University of Taipei, she has become a renowned authority in the field.
About peri-implantitis and the challenges of treatment, Dr Al-Falaki comments: “Peri-implantitis is becoming the epidemic of dentistry, and the biggest problem is that there is no gold standard way of treating it that guarantees long-term success.
The idea of ‘dental implants for life’ is sadly being disproven and, of course, patients pay substantial amounts of money to have dental implants placed, so when they start to fail this has a significant psychological impact. The cost of treatment is high, and the cost of replacing a dental implant that fails is even higher if it’s even clinically possible.
One of the surprising challenges
“Believe it or not, one of the surprising challenges of managing peri-implantitis is the actual diagnosis, and it’s an area that is poorly understood. Confidence to probe around dental implants to aid diagnosis has been a big issue in the past, but we’re getting better at that.
However, it’s almost a case of ‘oh dear — there’s bleeding around the dental implant — now what do | do?!’, and it may get left for another six months.
This disease process cannot be left for that long — it progresses so rapidly and the longer it is left, the more complicated and less predictable possible treatment outcomes become. The aetiology is complex, so the decision tree for management is not in the slightest bit straightforward. It usually involves the need for surgery, which most are not confident in performing.”
Dr Al-Falaki goes on to discuss the current management concepts available for peri-implantitis, highlighting the benefits of treatment with laser technology: “Treatment aims to manage the active disease process, while also trying to address the aetiological factors.
In most cases, there is a need for surgical treatment, which may just be for access and decontamination. This might include bone grafting, altering morphology to improve access for oral hygiene, and/ or soft tissue work such as grafting to increase the zone of keratinised tissue and vestibular releases to limit mobility.
“Lasers can help in all of these steps (depending on the type of laser), and so far the research is very promising as to the effectiveness lasers have in decontaminating and cleaning the dental implant surfaces, as well as restoring biocompatibility — which is your gold standard ideal outcome.
More attractive Still is the ability in most cases to be able to treat peri-implantitis with a flapless approach in mild to moderate cases, which of course requires less time and less expense.
This also helps to achieve better aesthetics and causes far less morbidity for our patients, offering an easier procedure for the clinician and less stress.
That’s just a few of the advantages.”