Univ.-Prof. Dr. Moritz Kebschull, Chair of Restorative Dentistry, University of Brimingham, United Kingdom
Univ. Prof. Dr. Dr. Ralf Gutwald
Dean of the DPU and Coordinator of Scientific Continuing Education and Postgraduate Studies of the Danube Private University (DPU), Krems
The knowledge of how inflammatory periodontal destructive processes occur has been deepened and expanded in recent years. It is the tissue response itself, caused by microbial irritation from subgingival biofilms, that initiates the destruction of the marginal periodontium and also shows systemic effects as chronic periodontitis. New therapy approaches have therefore been developed to supplement mechanical therapy. These have made enormous progress in terms of methodology and instrumentation. Due to the contemporary demand for the protection of tissue with regeneration potential, the generous periodontal flap operations have been replaced by delicate, reconstructive and repairing methods that are able to meet even the highest aesthetic standards. However, there are limits to both perio-therapy and endo-therapy. Teeth are removed and replaced by implants.
The favourable assessment of the quality and quantity of the alveolar bone as well as the thickness of the mucosa using appropriate modern methods is the primary requirement for the correct insertion and problem-free retention of implants in edentulous jaw sections. If therapeutically necessary, the jawbone and/or peri-implant mucosa must be augmented beforehand using plastic perio-surgery methods to ensure that implants are perfectly anchored. The minimum thickness is determined by the short-term and long-term biological reactions in the peri-implant soft and hard tissue and is absolutely necessary. Processes also take place in the mucous membrane and the peri-implant bone – caused by microbial biofilm – which can be compared to those in the marginal periodontium. However, due to micromorphological differences, the inadequately conditioned peri-implant soft tissue reacts more intensively, the inflammatory processes are much more difficult to control, and they spread much faster into deeper tissues.
Periodontal therapeutic measures and implants require personal and professional follow-care without exception. Modern mechanical, hydrodynamic and chemical aids are included in daily oral hygiene according to the patient's manual skills. Professional follow-up care is always required and should take place at regular intervals, even with good oral hygiene.