Dental School – University of Paris VI (France)
Residency in Periodontology – University of Washington (USA)
Master in Education – University of Florida (USA)
Former Assistant Professor – University of Florida (USA)
Chargé de Cours – University of Paris V
Former President of the French Society of Periodontology
Former President of the European Federation of Periodontology
Private practice limited to Periodontics and Oral Implantology
Scientific Director of Quintessence International
To make a decision of conserving an implant in function presenting an infectious complication needs a comprehensive approach of the clinical situation and should consider the biological profile of the patient as well as the presence of local risk factors. Implant removal should never be excluded. Most treatment modalities of peri-implant diseases are adapted from those used for the treatment of periodontal diseases; the primary therapeutic approach being aimed at controlling infection. This may involve adjustment of prostheses to allow for proper oral hygiene and professional removal of the biofilm and hard deposits from the implant surface. In advanced peri-implantitis cases a surgical approach may be necessary to gain access to disrupt and remove the biofilm. If appropriate at such a surgical intervention, regenerative treatments to regain the lost bone may also be performed. At present there are limited scientific data on the treatment of peri-implant diseases, and therapeutic interventions in peri-implantitis cases are, in many instances, based on clinical experience. However, research activity in this field is very high, and new data are continuously produced with the expectation of clearer guidelines for the treatment of these conditions in the future.
After 30 years of experience in the use of implants in periodontal patients, it is time to look in the mirror and to analyze all the complications and failures which became source of nightmare.
The most impressive failures which may lead to pathetic situations find their origin in the weak control of factors which can be classified in different categories.
Biological factors linked to the severity of periodontal disease. In spite of proper treatment, we may be faced also with severe situations in refractory cases and some general risk factors should be considered as contraindication to any implant therapy.
Technical factors linked to the complexity of the cases. In advanced cases, implant placement is just a single step of a multidisciplinary treatment requiring a good coordination with other disciplines. When you practice as a specialist working with referral dentists, you may be faced with some catastrophes due to suprastructure design.
Subjective factors linked to the patient profile. The psychological profile of the patient may influence directly the quality of the outcomes. In the same way, the socioeconomic environment, and the financial cost of the treatments which can provoke nightmares for both the patient and the practitioner.
Therefore, to sleep properly we should learn to say NO more often.