Article

Feature Article
Abstract

The topic of Group 3 was "Oral Medicine", which addressed the influence of both material- and anti-resorptive drug-associated factors on clinical and biological outcomes and complications in implant dentistry. Focused questions addressed the following 3 categories: (1) Implant materials other than titanium (alloys); (2) Transmucosal abutment materials other than titanium (alloys); (3) Medications affecting bone metabolism. After more than 2 years of preparation as well as 72 hours of lively debate between almost 100 experts in the field of implant dentistry, Group 3 defined the following statements and recommendations:

Zirconia is a valid alternative to titanium as a material for implants and transmucosal components, allowing soft and hard tissue integration with clinical outcomes comparable to titanium (up to 5 years) – identified by implant survival, marginal bone loss and peri-implant probing depths. However, the current state of evidence remains limited, especially for 2-piece implant designs. Based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone.

Administration of low-dose anti-resorptive drugs (ARD) did not show any negative impact on early implant outcomes, but careful follow-up and supportive care is recommended in order to prevent peri-implant medication-related osteonecrosis of the jaw and implant-related sequestration. However, existing dental implants without peri-implant pathology should not be removed. In addition, withholding anti-resorptive drugs (drug holiday) for implant placement is not recommended.

For further details, please refer to the 7th ITI Consensus Conference Group 3 Consensus Report and review articles that can be downloaded from the ITI website.

Introduction

Every 5 years, the ITI conducts a Consensus Conference to review the current state of evidence in areas of interest in implant dentistry. For the 7th ITI Consensus Conference, based on input from the editors of several dental journals as well as ideas proposed by the members of the Steering Committee, the following five topics were selected: Surgical Techniques, Technology, Oral Medicine, Patient Benefits, and Implant Placement and Loading Protocols. Group 3, which discussed “Oral Medicine”, was headed up by two group leaders, Prof. Bilal Al-Nawas and Prof. France Lambert and three main authors, Dr. Isabelle Laleman, Dr. Stefan Roehling, and Prof. Yong-Dae Kwon, assisted by experts in the field from all over the world. The question “why oral medicine?” is based on the fact that all treatment providers must have a deep understanding of which materials are biocompatible and what kind of medication has an effect on implant treatment in both the short and the long term. Thus the objectives of Group 3 were to address the influence of both material- and antiresorptive drug-associated factors on clinical and biological outcomes and complications in implant dentistry. Focused questions addressed the following 3 categories:

  1. Implant materials other than titanium (alloys)
  2. Transmucosal abutment materials other than titanium (alloys)
  3. Medications affecting bone metabolism

Three systematic/narrative reviews formed the basis for discussion within the working group and were prepared and reviewed before the Consensus Conference. The reviews were discussed within the group, and Consensus Statements, clinical recommendations and patient-oriented questions and answers were formulated and then presented to the plenary for approval. The working group also prepared recommendations for future research. The aim of this narrative review is to highlight and present the findings and recommendations of Consensus Conference Group 3 and how to potentially implement these in everyday clinical practice.