On clinical results of oral implants

Content
Oral implants succeed quite well even if results from many clinical studies using the so called simple CSRcurve overestimate the true clinical outcome; many implant problems may remain undetected in this type of reporting. The four-field table or a more stringent CSR reporting, both techniques including data on bone loss and unaccounted for implants, would be far better approaches to report clinical results than the simple CSR curve that lamentably is dominating clinical reporting today. Furthermore, there are recent reports that may be interpreted as if oral implants are threatened by peri-implantitis in a great proportion of cases, had this been correct it would have threatened the clinical longevity of our procedures. However, when carefully scrutinized, the evidence for primary periimplantitis builds on findings from ligature studies of very little clinical significance, in reality the healing adaptation theory explains undue bone loss much more reliably than any peri-implantitis theory. The healing/adaptation theory, recently published by Chvartszaid, Koka & Zarb in a quintessence book, explains early failures/bone loss by compromised healing that may occur as result of some biologic malfunction or delay or as a result of harshness of a surgical intervention; it further explains postloading failures/bone loss to be due to inability of the host to adapt to the challenges placed on the implant interface, not uncommonly due to a synergy from a multitude of factors. Having said this, if primary periimplantitis in reality is a most rare, if at all existing, single condition behind implant bone loss, a late result of bone loss for other reasons, may naturally be termed secondary peri-implantitis since the implant interface may then be characterized by inflammation or even infection.