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Lokale Risikofaktoren für Implantatverluste

Local risk factors for loss of implants

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Zusammenfassung

Ausgehend von der Beobachtung, dass bei Patienten in einer Reihe von Implantaten häufig nur einzelne von Periimplantitis befallen sind, werden in dieser Übersichtsarbeit lokal auslösende Faktoren für diese Erkrankung diskutiert. Mangelndes Knochenvolumen und schlechte Knochenqualität sind klar anerkannte Risikofaktoren für Früh- und Spätverluste (Periimplantitis). Das Schicksal eines Zahnimplantats entscheidet sich auf dem obersten Millimeter durch eine sichere Knochenbedeckung der aufgerauten Titananteile und durch einen intakten Weichteilanheftungsapparat. Zur Frage, ob ein Implantat keratinisierte Gingiva von mehr als 2 mm benötigt, ist festzustellen, dass dies nur für die Ästhetik (Rezessionsvorbeugung) und die Hygienefunktion und nicht für die Implantatverlustrate und Sondierungstiefen belegt ist. Ebenso verhält es sich mit der Weichteildicke und dem parodontalen Biotyp. Knochen ist daher ein wichtiger lokaler Erfolgsfaktor für Zahnimplantate. Bei Mangel sollte er aufgebaut werden sollte, um Voraussetzungen für eine langfristige Implantatgesundheit zu schaffen. Der langfristige Erfolg von Weichteilaufbaumaßnahmen ist in der Literatur schlechter belegt als der langfristige Bestand von Knochenaufbaumaßnahmen.

Abstract

Based on the observation that in patients only isolated implants out of a whole series are actually affected by peri-implantitis, this review article discusses the local factors causing this disease. Deficient bone volume and bone quality are widely accepted as risk factors for early and late loss (peri-implantitis) of dental implants. The fate of a dental implant is determined by the uppermost millimeter of the implant neck. The roughened titanium parts in the neck area of an implant should be completely covered by circular bone attachment as a basis for an intact soft tissue sealing zone. For the question whether an implant needs more than 2 mm of keratinized gingiva, it has been confirmed that this is only necessary for aesthetics (e.g. prophylaxis of gingival recession) and aspects relating to hygiene (e.g. plaque control); however, lack of keratinized gingiva has not yet been definitively correlated with the rate of implant loss and probing depth. The same applies to the gingival biotype and the thickness of the soft tissue in the emergence area of an implant. Bone is therefore an important factor for the success of dental implants and lack of bone should be treated by augmentation as a prerequisite for achieving long-term healthy implants. In the literature the long-term stability of soft tissue augmentation is less well documented that of bone augmentation.

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Authors and Affiliations

  1. Mund-, Kiefer- und Gesichtschirurgie, Rotes Kreuz Krankenhaus Kassel Gemeinnützige GmbH, Hansteinstr. 29, 34121, Kassel, Deutschland

    H. Terheyden

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H. Terheyden gibt an, dass er in den vergangenen drei Jahren Forschungsmittel aus der ITI Stiftung und Honorare für Kurse und Kongressvorträge von den Firmen Straumann, Geistlich, Dentsply, Camlog erhalten hat.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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M. Bonsmann, Düsseldorf

H. Terheyden, Kassel

H.-P. Ulrich, Lübeck

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Terheyden, H. Lokale Risikofaktoren für Implantatverluste. MKG-Chirurg 9, 116–123 (2016). https://doi.org/10.1007/s12285-016-0048-3

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