Marc Quirynen: Give the bone a chance to survive

The etiology of complex chronic infections like peri-implantitis demand a multi-causality model to explain the condition. Peri-implantitis is not always caused by pathogens. Dr Quirynen reviews that peri-implantitis can be caused by more than one causal mechanism, that every causal mechanism involves the joint action of several causes, most causes are neither necessary nor sufficient to produce disease by themselves, removal of a single cause will not necessarily lead to prevention of the disease, and blocking of a cause will significantly reduce the incidence of the disease. The model makes clear that the understanding of the etiology is nearly impossible, and that the outcome of the peri-implantitis therapy will depend on many factors. Dr Quirynen concludes and summarizes the main influences: host response, hygiene, pathogens, implant and prosthetic component design and manipulation, augmentation procedures and cement excess removal.