Designing Against Disease: Objective Principles for Long-Term Peri-Implant Health

<jats:p>This chapter aims to provide clinicians with a solid, evidence-based foundation on the minimum biological and prosthetic requirements necessary to achieve long-term success in implant-supported rehabilitations, avoiding complications such mucositis and peri-implantitis. As stated by the latest consensus meeting on this pathology, prevetion is still the gold standard because a definitive treatment is still missing. Patient selection and the identification of a periodontal desease to treat and stabilize before an eventual implant rehabilitation should be always the first concern. After that, the correct surgical and prosthetical planning is fundamental to reduce the possibility of implant surface exposure and infection. At this purpose, an initial introduction on peri-implantitis carachteristics, pathogeneis, and diagnosis is followed by the definition of the critical thresholds of peri-implant bone volume to maintain marginal bone stability Nevertheless, peri-implant soft tissue dimensions require minimal vertical and horizontal thickness to ensure health over time. In addiction to that, even keratinized mucosal width should not be underrated. Moreover, the chapter will explore key prosthetic principles, including the selection of implant surface microtexturing, implant–abutment connection types, and the design of the prosthetic emergence profile. In the end, the discussion about the emergence profile angle and its link with plaque accumulation will be analyzed.</jats:p>