K. F. Chow BDS., FDSRCS November 13th, 2009

Thanks for the kind words guys. While I am yet feeling elated and therefore a little brash, let me push the debate a little further.

We all know that the transmucosal passage of the dental implant when compared to the transmucosal passage of an actual, real, original living tooth is actually a pathetic imitation of the real thing. The real thing has a nice epithelial attachment with a nice drain around the tooth constantly flushed with antibacterial substances and prohealth nutrients for the gingivae. Not only that the gingival cuff has circular fibres, connective tissue to tooth fibres, bone to tooth fibres , connective tissue to bone fibres etc. that gives each tooth a nice firm resilient yet elastic cuff around the it. Go review your periodontology texts and see for yourself.

The dental implant has only a pseudo epithelial attachment and a few if any specialised soft tissue fibres and at best is actually an iatrogenic and pathetic imitation of the original! The Archilles heel of dental implants is this transmucosal passage. Peri-implantitis is a problem we all have to tackle like periodontitis. And with dental implant placement growing in the double digits around the world, it is going to be an increasing problem.

The best solution is probably a tooth germ implant which may be a generation away. We may be stuck with dental implants for some time yet.
One way to tackle it and hopefully to decrease the incidence of peri-implantitis may be to decrease the diameter of the implants as it emerges through the mucosa. One shortcoming of conventionals is its large diameter especially done in the name of an aesthetic emergent profile. Narrow diameters may be one of the answers to decreasing and managing the incidence of peri-implantitis.

Nuff said.