Implant-Supported Crown Design and the Risk for Peri-Implantitis

Focused Clinical Question: Is dental implant crown design and overcontour a risk for peri-implantitis? Summary: Peri-implantitis is a very significant complication in implant therapy caused by bacterial infection on the implant surfaces. Peri-implantitis can become a liability issue in clinical practice, mainly because of the patient's expectation, additional expense involved, and the need for additional surgical and restorative procedures. The use of preventive plaque control measures and strict recall programs are very important in clinical practices involved in implant dentistry. There are many risk factors associated with peri-implantitis, such as biologic, mechanical, and iatrogenic. This paper focuses on the potential risk associated with implant-supported over-contoured restorations, which favor bacterial biofilm accumulation and, most importantly, restrict appropriate hygiene access by the patient and the dental care provider, leading to peri-implant mucositis and peri-implantitis. This paper also suggests the need for increasing communication among the implant team members, including laboratory technicians. The use of three-dimensional computer technology for dental implant restorative design is suggested as a tool to improve communication. Conclusions: Restorative planning and design of dental implants may be crucial to reducing the number of peri-implantitis cases. This paper should improve the awareness of the importance of proper crown design on non-submerged one-stage dental implants and emphasize the risks for soft-tissue inflammation and peri-implantitis when implant-supported restorative crowns are overcontoured.