SPEAKER: Associate Professor Tino Mercado

TOPIC: Biological complications of peri-implant diseases: when to manage, when to refer, and when to surrender.
VENUE: University of Otago, Hunter Centre Seminar Room, 362 Leith Street, Dunedin

Synopsis:
This lecture by Associate Professor Dr Tino Mercado presents an evidence-based, case-driven framework for recognizing, diagnosing, and triaging biological complications related to dental implants. Attendees will review current concepts of peri-implant mucositis and peri-implantitis, including epidemiology, pathogenesis, risk indicators such as history of periodontitis, smoking, diabetes, prosthetic or iatrogenic factors, and the impact of implant position and prosthesis design. The session covers practical diagnostic workflows, baseline records, and radiographic comparisons to stage disease and assess complexity. The lecture builds on diagnosis by outlining a stepwise decision pathway: identifying cases suitable for management in general practice, determining when to refer to periodontists, implant surgeons, prosthodontists and recognizing when implant removal is necessary. Both non-surgical and surgical options are critically reviewed, including debridement technologies, chemotherapeutic and antimicrobial adjuncts, implant surface decontamination, respective and regenerative approaches, implantoplasty, and soft-tissue augmentation. The session also emphasizes prevention, supportive peri-implant maintenance protocols, effective patient communication, informed consent, documentation, medico-legal considerations, and cost–benefit counselling. Attendees will gain practical triage criteria, treatment algorithms, and maintenance strategies for immediate implementation, illustrated with real cases ranging from straightforward mucositis to complex explanation and site reconstruction.

Learning Outcomes:
1) Differentiate peri-implant mucositis from peri-implantitis using clinical and radiographic criteria, including interpretation of baseline vs current bone levels.
2) Identify patient, implant, and prosthesis-related risk factors that increase disease susceptibility and complexity.
3) Apply a structured triage algorithm to decide when to manage in-house, when to refer to a specialist team, and when to plan for implant removal.
4) Formulate and sequence non-surgical management for peri-implant mucositis and early peri-implantitis, including biofilm control, instrumentation choices, decontamination options, and behavioural change strategies.
5) Select appropriate surgical approaches for peri-implantitis based on defect morphology and aesthetic demands, and understand indications/limitations of respective surgery, implantoplasty, and regenerative protocols.
6) Recognize cases with unfavourable anatomy or prosthetic design (malposition, residual cement, over contoured restorations, limited keratinized tissue) and plan corrective or referral-based interventions.
7) Establish criteria for “surrender” (explanation) such as implant mobility, advanced vertical bone loss, recurrent infection despite therapy, non-restorability, or unacceptable risk–benefit and outline post-explanation site management and prosthetic alternatives.
8) Develop individualized supportive peri-implant maintenance programs, including recall intervals, home-care prescriptions, and monitoring metrics to prevent recurrence.
9) Communicate prognosis, risks, and treatment options effectively to patients; obtain informed consent; and document findings and decisions to meet medico-legal standards.
10) Collaborate effectively with hygienists, dentists, periodontists, prosthodontists, and surgeons to coordinate care for complex cases.