What’s more important, The Implant or the Hard and Soft Tissues  Around the Implant?

What’s more important, The Implant or the Hard and Soft Tissues Around the Implant?

What’s more important, The Implant or the Hard and Soft Tissues

Around the Implant?

Implant designs and innovations have continually advanced since the first implants were
introduced. Be it titanium or zirconia, the surface textures of the implants , the “platform switch”
abutments, narrowed abutment diameters, and or conical implant connections, all have been
engineered to appeal to the surrounding bone and soft tissues. During this maturing process of
the implant market, increased research and clinical education has removed many variables
associated with implant placement. The ultimate goal of implants has been to mimic how a
natural tooth functions and to become welcomed inhabitant of the native surroundings. During
this evolution of designs, innovations and clinical experience, new variables to success were
discovered. Micro-Movement of Implant components during mastication has brought to light two
aspects. 1. An abutment may loosen and need tightening. 2. Biofilm/Bacteria ingress and
egress from the implant abutment junction plays a negative role regarding surrounding tissues.
Peri mucositis which is reversible but if left unchecked, non-reversible peri implantitis can
progress as a result the egress of bacteria from the implant.
This lesser discussed issue of micro-movement leading to mico-leakage, is increasingly
appearing in the literature and in lectures.* Leakage into and from the implant abutment joint is
recognized to be a strong influence in the overall health of hard and soft tissues around the
implant. While implant designs have claimed to minimize or prevent leakage into and from the
implants they do not.* As the patient functions on the implant, the implant abutment junction
continues to flex and wear, pumping saliva, nutrients and oral flora into the implant chamber
from the peri-implant area.*The effort to seal the internal chamber of the screw channel and its
contents has become a serious subject in Europe and now in the United States. When bacteria
is allowed inside the abutment and then into the delicate zone where bone, connective tissue,
implant and abutment all merge, new considerations should be addressed. (Figure 1) What
covers the implant access screw now becomes a real subject for the health and future of the
surrounding tissues.
Although Cotton was never intended for use under definitive restorations, cotton is currently
used in a large percentage of practices and Dental Schools. Teflon Tape (PTFE) although
banned in Europe, PTFE used substantially in the United States. Cavalcanti et al* confirmed
that the number of infiltrating microorganisms when PTFE was used was equivalent to that for
the groups with no sealing, independent of the implant system evaluated.*
In Europe, Scandinavia, Australia and in South America, alternatives for cotton and teflon have
been sought to prevent the effects of bacterial egress from implants. One such device,
SilverPlug®, ( www.SilverPlug.US ) has been clinically utilized for more than10 years around the
world and is now available in the United States. Utilizing non-leaching nano-silver technology in
a conical form, SilverPlug® is designed to fit any implant and prevent the internal growth and
proliferation of anaerobic bacteria. SilverPlug® is certified and carries a MDR Class IIa approval
from the EU and is FDA compliant in the United States. Clinical experience is the proof of
efficacy. Reports from Clinicians include, tremendous reduction in Mucositis, Crestal bone loss
and total lack of the odor when reentry is needed for adjustments. (Figure 2)
The road to success is paved with many variables. Advancements and innovations of implant
designs and surfaces has been significant. The road to success has also revealed bacterial
variables that can and do effect the most desired tissue responses. Both characteristics are

* Studies Available Upon Request

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