Periospot

05/05/2026

The implant is fine. The bone is fine. The prosthesis is the problem.
This is the conversation no one wants to have. A 2025 systematic review and meta-analysis by Lin et al. in the Journal of Periodontology made it unavoidable.
Four prosthetic factors with measurable bone consequences.

Emergence angle. 30° + convex profile: higher peri-implantitis risk. The convex bulge creates a plaque trap.
Abutment height. ≥2 mm: less marginal bone loss.

05/05/2026

Why Your Implant Will Never Be a Tooth

Your implant will never be a tooth. It is not supposed to be.

Two cross-sections look almost identical from the outside. Inside, the biology is fundamentally different.
A natural tooth is suspended in its socket by a periodontal ligament 0.15 to 0.25 millimeters wide. The PDL is a sensory organ. It contains capillaries, mechanoreceptors that detect bite force differences as small as 1 to 3 grams (Trulsson, 2006), and an organized fiber architecture that runs perpendicular to the root via Sharpey's fibers.
A dental implant has none of this. Osseointegration is direct bone-to-titanium contact. There is no PDL, no mechanoreceptor feedback, and no interface vascular plexus.
The soft tissue differs too. Gingival fibers around a tooth run perpendicular to the root and insert into cementum. Peri-implant connective tissue fibers run parallel to the implant surface (Berglundh et al., 2018). The architecture is a sleeve, not a seal. Bacteria migrate faster.
Mechanically, a tooth compresses approximately 50 micrometers under load. An implant moves 3 to 5 micrometers. Force concentrates at the crestal bone. The brain receives no proprioceptive feedback. Patients can fracture implant crowns without feeling it.
Honest caveats. This is not anti-implant. With careful case selection and maintenance, implants remain profoundly successful. Some patients develop partial bone-mediated proprioception (osseoperception). It is real but limited. Bone density and quality vary between patients.
The point. Implants are not artificial teeth. They are different structures. They need different maintenance rules and different mental models.
Save this. Share it with the next patient who tells you their implant feels like a real tooth.
References

Berglundh et al. J Periodontol Suppl. 2018
Trulsson M. J Oral Rehabil. 2006
Cooper LF. Front Oral Maxillofac Med. 2025
Herrera et al. J Clin Periodontol. 2023

05/05/2026

Same bone. Same titanium. Different patient. Different outcome.
The 2025 AO and AAP systematic review and meta-analysis pooled 102 studies, 13,030 patients, and 39,991 dental implants (Galarraga-Vinueza et al., J Periodontol, 2025).
The numbers, at the patient level.
Peri-implant mucositis prevalence: 46 percent (95% CI 41 to 51).
Peri-implantitis prevalence: 21 percent (95% CI 17 to 24).
Cumulative incidence at the patient level.
Within 5 years: peri-implantitis 12 percent (95% CI 7 to 19), mucositis 46 percent.
Within 10 years: peri-implantitis 14 percent (95% CI 9 to 20), mucositis 61 percent.
Within 20 years: peri-implantitis 22 percent (95% CI 11 to 36), mucositis 53 percent.

History of periodontitis: peri-implantitis OR 2.92 (95% CI 2.05 to 4.13).
Smoking: peri-implantitis OR 2.27 (95% CI 1.68 to 3.06).
Diabetes mellitus: peri-implantitis OR 2.31 (95% CI 1.59 to 3.32).
Alcohol consumption: peri-implantitis OR 2.07 (95% CI 1.49 to 2.85).
Obesity: mucositis OR 3.29 (95% CI 1.75 to 6.17).
Edentulous arch subgroup carries the highest disease burden. Peri-implantitis prevalence 33 percent (95% CI 3 to 73, very wide heterogeneity).

The honest caveats.
Heterogeneity is high. I-squared values reach 94 to 95 percent. Different case definitions, different protocols. These are risk indicators, not proven causal factors. Most data come from university clinics, where maintenance compliance is higher than in many real-world settings.
The clinical implication is uncomfortable but clear. The strongest predictors of peri-implant disease are not surgical and they are not prosthetic. They are at the patient level. The implant matters. The technique matters. But the patient matters more.

Galarraga-Vinueza et al. J Periodontol. 2025
Wang et al. AO/AAP Consensus. 2025
Cafferata & Schwarz. Front Dent Med. 2026
Berglundh et al. J Periodontol Suppl. 2018

05/05/2026

Peri-implantitis is a brain disease.
Provocative? Yes. Evidence-based? Increasingly so.
A March 2026 mini review by Cafferata and Schwarz in Frontiers in Dental Medicine consolidates the case (Cafferata & Schwarz, 2026).
The chain of evidence.

CRP is up to 3x higher in peri-implantitis patients than in healthy implant controls. IL-6 is nearly doubled. They reach the bloodstream. They reach the brain. They activate microglia. They cross perivascular spaces. They participate in the inflammatory pathways that, in longitudinal cohorts, predict accelerated cognitive decline, reduced gray matter, and reduced hippocampal volume (Kipinoinen et al., 2022; Singh-Manoux et al., 2014; Satizabal et al., 2012).
A 2025 clinical trial showed that treating peri-implantitis significantly reduces circulating CRP, LDL cholesterol, and TNF-alpha within 6 months.

The honest version of the same statement.
"Brain disease" is a deliberate reframe. The clinical category remains peri-implantitis. The mental model is what should change. The cognitive evidence is observational, not interventional. Causation has not been demonstrated by RCT. Confounders include age, frailty, socioeconomic status, oral hygiene, and multimorbidity.
And a critical clinical caveat. Up to 50 percent of peri-implant adjacent malignant lesions are initially misdiagnosed as peri-implantitis, with final histology revealing squamous cell carcinoma in up to 97 percent of cases. Persistent or atypical lesions deserve histopathology, not assumption.
The most quietly devastating finding from the review has nothing to do with biology.
89 percent of patients with peri-implantitis-affected implants believed their implants were healthy.
You cannot ask a patient to maintain something they do not know is sick.
Treat the pocket. Protect the cortex.

Cafferata EA & Schwarz F. Front Dent Med. 2026
Galarraga-Vinueza et al. J Periodontol. 2025

01/05/2026

The Strategic Surgeon: A Lesson in Biology

He always placed implants in the laterals.
Four missing incisors, two implants, lateral position. Obvious. Done it
a hundred times. Never questioned it.
Until his mentor told him about a battle.
In 1385, six thousand Portuguese soldiers faced thirty-one thousand
Castilians. Everyone predicted a massacre. Portugal won. Not because
they were stronger. Because they knew the terrain and chose the right
position.
That night, the surgeon looked at his plan again. Really looked.
The implant platform invading the papilla. 1.5 mm to the canine.
Buccal bone already paper-thin. The "obvious" position was the worst
position on the battlefield.
He moved the implants to the centrals.
Everything changed. More bone. Platform switching protecting the crest.
Protrusive forces landing exactly on the implants. Lateral forces on
the canines. The laterals sitting out of occlusion. Guided surgery
locking every millimetre into place.
The Portuguese didn't win because they were bigger. They won because
they studied the battlefield.
In implant dentistry, the battlefield is biology. And the right position
is not always the obvious one.
Full clinical breakdown with animations at periospot.com (link in bio)

01/05/2026

The moment a dental implant goes into your jaw, a race begins.
Minutes in: blood proteins grab the titanium. Your body shakes hands with the metal.
Weeks 2 to 3: osteoblasts arrive and weave a scaffold of woven bone directly onto the threads.

Week 6: 60 to 70% of the surface is already covered in fresh bone.

Months later: that disorganized bone is slowly replaced by dense, organized lamellar bone. The strongest you have.

Month 4 to 6: implant and jaw are no longer two things. They are one structure.
The name for it: osseointegration. The reason implants achieve 95 to 98% success (Albrektsson & Johansson, 2001).

The surgeon places the implant. Biology does the rest.

📚 periospot.com

30/04/2026

Preventing Buccal Soft Tissue Dehiscence

The perfect implant result. Natural emergence. Beautiful soft tissue contour. That's the goal.
But this is what too many patients actually get: grey metal showing through the gum line. Buccal soft tissue dehiscence.
It is one of the most common aesthetic complications in implant dentistry. And it is almost always preventable.
The causes? Implant positioned too buccally. Thin tissue biotype. Insufficient buccal bone (less than 2mm). Implant placed too shallow.
Take any one of those factors, and you're rolling the dice on the final aesthetic result.
The fix is not corrective surgery. The fix is planning.
Palatal positioning. Adequate depth. At least 2mm of facial bone. Thick soft tissue, grafted if needed.
Based on Sanz-Martin et al., 2019.
Full article on periospot.com (link in bio)

30/04/2026

The Tsar Who Pulled Teeth

🦷 THE TSAR WHO PULLED TEETH
In 1697, Peter the Great (6'8") disguised himself as a carpenter and traveled to Amsterdam. There, the Dutch anatomist Frederik Ruysch taught him anatomy, surgery, and tooth extraction.
Peter became obsessed. He carried dental instruments everywhere and personally extracted teeth from soldiers, courtiers, bishops, and reportedly even his wife. Many of the teeth were perfectly healthy. Nobody could refuse. He was the Tsar.
He kept every tooth: 33 of them, each wrapped in ribbon, stored in numbered boxes. You can see them today at the Kunstkamera in Saint Petersburg, the museum he himself founded.
In 1710, Peter also issued Russia's first official dental license, to a Frenchman named François Dubrel, effectively launching the profession in Russia.
📍 Historical note: While Peter's tooth collection is well-documented and on museum display, some of the more colorful anecdotes (pulling healthy teeth, courtiers hiding) come from historical accounts that blend fact with legend.
🎬 Full story in this video.

30/04/2026

The books that shaped my clinical thinking. Zero are about teeth (and that's the point). https://periospot.com/blog/how-to-do-a-webinar-about-dentistry-that-your-audience-will-love

We have reached a point that if we invite a friend to a webinar about "How to Place an Immediate Implant in a Giraffe", our friend will most likely decline the

30/04/2026

Mudou minha prática: posição 3D, estética. Quem dera eu soubesse disso em 2010. https://periospot.com/blog/the-ideal-implant-position-in-the-aesthetic-zone-pt

Este artigo descreve as regras sobre a posição ideal do implante na zona estética.

30/04/2026

Want to get better at practice management, business? These resources changed my practice. https://periospot.com/blog/10-frequent-mistakes-in-dental-practice-management-and-how-to-avoid-them

The 10 most frequent mistakes in dental practice management and how to avoid them — evidence-based strategies for clinical excellence and team performance.