Innovations for Implants

Alex Gillone, DDS, MS (AG): A significant amount of research is focused on peri-implant mucositis and peri-implantitis. When compared with periodontitis, these conditions do not respond as predictably to the treatment modalities that are currently available. The development of new, more effective treatment modalities would be very beneficial. In addition, the American Academy of Periodontology and other associations from around the world have developed a joint classification system for peri-implant health and disease. This has made communication easier and improved diagnosis.

ACELA MARTINEZ, DMD, MS (AM): New research regarding the management of soft tissue around implants is needed for many reasons, such as improving the treatment of peri-implantitis and pre- or postoperative biotype conversion to prevent recession or other esthetic problems in the long term. A significant amount of research has been conducted regarding the importance of adequate soft tissue and keratinized tissue around implants, and that is worthy of attention in the interest of long-term peri-implant health. The many advances in materials for bone regeneration also are worth monitoring.

ID: What developments have you seen in implant design?

AG: Manufacturers are now offering implants that are specifically designed for immediate placement. These incorporate features such as more aggressive threading.

AM: Also, there are new advances and designs regarding implant platforms/abutment connections with the objective of preserving crestal bone.

ID: Are implants made from new materials viable?

AG: I am considering researching ceramic implants because they could be a good product to fill a certain niche. I envision them being useful for patients with allergies to titanium or patients who simply prefer an alternative to metal. Some providers also prefer to use ceramic in the esthetic zone because it results in less show-through than metal in areas where the soft tissue is thin. Long-term data are still being collected, but studies seem to suggest that they are successful.

ID: How about components such as abutments and attachments?

AM: For implant-retained restorations, the preferred option has always been screw retention, but limitations existed. Now, however, the use of angled screw channel abutments can help correct angulation issues, permitting the delivery of more restorations that are easier to retrieve and avoid the risks associated with excess cement. Another development is CAD/CAM custom abutments, which allow us to execute our surgical and restorative planning together to achieve important synergies. Regarding multi-unit abutments for full arches, the industry is also looking into designs that try to maintain the bone with smoother transitions from the gingiva. In addition, many innovative attachment systems are now available for overdentures, such as stud-style and hybrid systems as well as some that offer greater angulation.

AG: Some of the options have been around for a while but were not widely available until more recently. Now, most implant brands have an option for angled screw channel abutments. Also, many companies now provide color-coded components, which is convenient. Everything is becoming more sophisticated.

ID: Where does the profession stand regarding implant placement techniques?

AM: Guided surgery is becoming more affordable and more common. Many clinicians are using software to design surgical guides and printing them with in-office 3D printers. We are even using printed guides for simpler cases. These protocols can be more precise and shorten the clinical time and the number of appointments for the patient. We can even print custom healing abutments and provisional restorations.

Alex Gillone, DDS, MS
Division Director of Periodontology
East Carolina University
School of Dental Medicine
Greenville, North Carolina

Acela Martinez, DMD, MS
Division Director of Clinical Implantology
East Carolina University
School of Dental Medicine
Greenville, North Carolina