Redefining Success in Implant Dentistry: Beyond Mere Implant Placement

摘要

Since Prof. Branemark established the concept of osseointegration—“a direct structural and functional connection between bone and an implant”—[1]; implant dentistry has been revolutionized, progressing techniques and materials for rehabilitating patients who lost their teeth using dental implants, biomaterials, and implant-supported prostheses [2]. After long years of clinical follow-ups, the use of dental implants proved to be a reliable long-term treatment for patients with unquestionable survival rates [2]. In the early ages of osseointegration, a successful osseointegrated implant was considered when after a healing period of 6–8 months, the bone-anchored implant was completely stable and surrounded by healthy and non-infected tissues, able to receive prosthetic loading and exercise mechanical function lasting long years in a patient [1]. After more than 50 years of successful use of dental implants, the clinical factors to declare a successful osseointegrated implant have changed [2-6]. Oral rehabilitation using dental implants has become a treatment dependent on specialized professionals who target handling complex long-term cases combining surgical, periodontal, and prosthetic approaches, thinking beyond just implant insertion and early osseointegration. Currently, the concept of implant success and its long-term osseointegration reveals a progressive complexity involving short and long-term factors in implant dentistry. Biological, mechanical, functional, technological, genetic, prosthetic, esthetic, and health quality indicators (PROMs) can be cited as actual components to determine implant and osseointegration success [2-6]. Nevertheless, many of these factors may bring up miscellaneous opinions of what should be considered “implant success” or “osseointegration success” in the currently available knowledge, as well as, patients may show different feedback's about their satisfaction with implant treatments. Osseointegration success may be considered a stable implant in oral function with the absence of inflamed/contaminated surrounding tissues and peri-implant bone loss. However, nowadays, the term “implant success” has achieved priority and embraces much more than healthy surrounding tissues; esthetics, correct implant positioning, treatment durability, changes in quality of life, and patient-related outcomes are crucial in the contemporaneous definition [6]. The evaluation of solely peri-implant tissue status is insufficient to achieve the current clinical scientific evidence needed to report quality of care, patient satisfaction, and treatment success in implant dentistry [6]. These multiple factors highlight the need for optimal surgical planning and safety protocols in implantology aiming for long-term clinical durability. On the other hand, questionable treatments with dental implants and diverse clinical decisions may currently emerge regarding maintaining, re-treating, or removing implants to redefine previous treatments or to achieve a different clinical scenario. Nowadays, it is possible to notice a growing number of implants being explanted or re-treated for different causes in dental clinics and/or institutions (e.g., incorrect implant-positioning, esthetic issues, peri-implantitis, bone loss, innovative prosthetic approaches, among others) [8]. Dental professionals have available an increased number of advanced technologies for implant treatments such as digital planning systems, innovative implant surfaces, guided and robotic surgeries, advanced biomaterials, and numerous prosthetic alternatives for bone-anchored implant rehabilitation; allied with that, guidelines for implant treatment have been created and wide scientific evidence is freely available [2, 5, 9, 10]. Technologies and guidelines that should promote high implant survival and success rates, along with long-term osseointegration without the need for additional interventions. However, the intense demand for esthetic treatments using dental i