{"id":7432,"date":"2026-09-17T06:00:00","date_gmt":"2026-09-17T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7432"},"modified":"2026-07-10T10:43:52","modified_gmt":"2026-07-10T10:43:52","slug":"perdua-ossia-en-implants-causes-prevencio-tractament-periimplantari","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/perdua-ossia-en-implants-causes-prevencio-tractament-periimplantari\/","title":{"rendered":"P\u00e8rdua \u00f2ssia en implants: causes, prevenci\u00f3 i tractament periimplantari"},"content":{"rendered":"\n

La p\u00e8rdua \u00f2ssia en implants <\/strong>dentals \u00e9s una de les complicacions m\u00e9s freq\u00fcents i importants de la implantologia a llarg termini. Encara que els implants dentals tenen taxes de superviv\u00e8ncia superiors al 95% a deu anys en condicions \u00f2ptimes, la p\u00e8rdua \u00f2ssia periimplant\u00e0ria progressiva pot comprometre l’estabilitat i la longevitat de l’implant si no es detecta i tracta a temps. Distingir la p\u00e8rdua \u00f2ssia fisiol\u00f2gica inicial de la patol\u00f2gica \u00e9s el primer pas per a un maneig cl\u00ednic correcte.<\/p>\n\n\n\n

Quanta p\u00e8rdua \u00f2ssia \u00e9s normal al voltant d’un implant?<\/h2>\n\n\n\n

Hi ha un consens cient\u00edfic ben establert sobre els l\u00edmits de la p\u00e8rdua \u00f2ssia periimplant\u00e0ria considerada fisiol\u00f2gica. Durant el primer any despr\u00e9s de la col\u00b7locaci\u00f3 de l’implant, una p\u00e8rdua \u00f2ssia marginal de fins a 1,5 mil\u00b7l\u00edmetres es considera dins dels par\u00e0metres normals, associada al proc\u00e9s de remodelaci\u00f3 \u00f2ssia que acompanya a l’osteointegraci\u00f3 i a la c\u00e0rrega funcional inicial. A partir del primer any, la p\u00e8rdua \u00f2ssia anual considerada fisiol\u00f2gica no hauria de superar els 0,2 mil\u00b7l\u00edmetres.<\/p>\n\n\n\n

Quan la p\u00e8rdua \u00f2ssia supera aquests llindars, especialment si s’acompanya d’inflamaci\u00f3 dels teixits tous periimplantaris, ha d’iniciar-se un proc\u00e9s diagn\u00f2stic per a identificar la seva causa i establir el tractament adequat abans que la p\u00e8rdua \u00f2ssia comprometi l’estabilitat de l’implant.<\/p>\n\n\n\n

Quines s\u00f3n les causes de la p\u00e8rdua \u00f2ssia periimplant\u00e0ria patol\u00f2gica?<\/h2>\n\n\n\n

Les causes de la p\u00e8rdua \u00f2ssia periimplant\u00e0ria patol\u00f2gica s\u00f3n m\u00faltiples i amb freq\u00fc\u00e8ncia se superposen en un mateix pacient. La periimplantitis \u00e9s la causa m\u00e9s freq\u00fcent i important: \u00e9s una malaltia inflamat\u00f2ria d’origen bacteri\u00e0 que afecta els teixits tous i duros que envolten l’implant, an\u00e0loga a la periodontitis en les dents naturals. La seva prevalen\u00e7a \u00e9s significativa: un metaan\u00e0lisis publicat en el Journal of Clinical Periodontology en 2017 va estimar que afecta aproximadament el 22% dels pacients amb implants a llarg termini.<\/p>\n\n\n\n

La sobrec\u00e0rrega oclusal \u00e9s una altra causa rellevant: quan l’implant rep forces masticat\u00f2ries excessives o mal distribu\u00efdes (per bruxisme, parafunci\u00f3 o un disseny prot\u00e8tic inadequat) pot produir-se p\u00e8rdua \u00f2ssia d’origen no inflamatori.<\/p>\n\n\n\n

El disseny i el posicionament de l’implant tamb\u00e9 influeixen: una col\u00b7locaci\u00f3 en posici\u00f3 incorrecta, amb un perfil d’emerg\u00e8ncia inadequat o amb un espai biol\u00f2gic insuficient, pot generar p\u00e8rdua \u00f2ssia independentment de la higiene del pacient. Finalment, factors sist\u00e8mics com la diabetis mal controlada, el tabaquisme, l’osteoporosi i determinats f\u00e0rmacs antirresortius poden comprometre la qualitat de l’os periimplantari i afavorir la p\u00e8rdua \u00f2ssia progressiva.<\/p>\n\n\n\n

Causa Mecanisme Factor de risc principal
Periimplantitis Inflamaci\u00f3 bacteriana Higiene oral deficient, periodontitis pr\u00e8via
Sobrec\u00e0rrega oclusal Estr\u00e8s mec\u00e0nic excessiu bruxisme, parafunci\u00f3
Posicionament incorrecte Espai biol\u00f2gic insuficient Planificaci\u00f3 quir\u00fargica inadequada
Tabaquisme Vasoconstricci\u00f3, immunosupressi\u00f3 local Consum actiu de tabac
Diabetis mal controlada Alteraci\u00f3 de la resposta immune HbA1c elevada
Antirresortius Reducci\u00f3 del recanvi ossi Bifosfonats IV, denosumab<\/p>\n\n\n\n

Qu\u00e8 \u00e9s la periimplantitis i com es diferencia de la mucositis periimplant\u00e0ria?<\/h2>\n\n\n\n

La mucositis periimplant\u00e0ria i la periimplantitis s\u00f3n les dues malalties periimplant\u00e0ries reconegudes pel consens cient\u00edfic actual, amb una difer\u00e8ncia fonamental entre elles. La mucositis periimplant\u00e0ria \u00e9s la inflamaci\u00f3 reversible dels teixits tous que envolten l’implant sense afectaci\u00f3 de l’os de suport: es manifesta amb sagnat al sondatge, enrogiment i edema de la mucosa periimplant\u00e0ria, per\u00f2 sense p\u00e8rdua \u00f2ssia radiol\u00f2gicament detectable.<\/p>\n\n\n\n

\u00c9s an\u00e0loga a la gingivitis en les dents naturals i respon b\u00e9 al tractament d’higiene professional. La periimplantitis, en canvi, implica inflamaci\u00f3 dels teixits tous amb p\u00e8rdua \u00f2ssia de suport progressiva: el sondatge periimplantari detecta bosses profundes amb sagnat o supuraci\u00f3, i la radiografia mostra una p\u00e8rdua \u00f2ssia en patr\u00f3 crateriforme al voltant del coll de l’implant. \u00c9s an\u00e0loga a la periodontitis i, igual que aquesta, requereix un tractament m\u00e9s complex i t\u00e9 menor capacitat de reversi\u00f3 espont\u00e0nia.<\/p>\n\n\n\n

Com es diagnostica la p\u00e8rdua \u00f2ssia periimplant\u00e0ria?<\/h2>\n\n\n\n

El diagn\u00f2stic de la p\u00e8rdua \u00f2ssia periimplant\u00e0ria combina l’exploraci\u00f3 cl\u00ednica amb el control radiol\u00f2gic peri\u00f2dic. En l’exploraci\u00f3 cl\u00ednica, el sondatge periimplantari amb una sonda periodontal de pressi\u00f3 calibrada permet mesurar la profunditat de bossa al voltant de l’implant, detectar sagnat o supuraci\u00f3 al sondatge i valorar la pres\u00e8ncia de placa bacteriana. El control radiol\u00f2gic (habitualment mitjan\u00e7ant radiografies periapicals estandarditzades amb t\u00e8cnica de paral\u00b7lelisme) permet quantificar la p\u00e8rdua \u00f2ssia marginal i comparar-la amb radiografies pr\u00e8vies.<\/p>\n\n\n\n

La comparaci\u00f3 amb la radiografia presa en el moment de la c\u00e0rrega de l’implant \u00e9s fonamental: sense una radiografia de refer\u00e8ncia inicial, \u00e9s impossible quantificar amb precisi\u00f3 la p\u00e8rdua \u00f2ssia acumulada. En Cl\u00ednica Belodonte el protocol de seguiment implantol\u00f2gic inclou radiografies periapicals de control a l’any de la c\u00e0rrega i posteriorment cada dos anys en pacients sense signes de malaltia periimplant\u00e0ria.<\/p>\n\n\n\n

Quin tractament existeix per a la periimplantitis i la p\u00e8rdua \u00f2ssia periimplant\u00e0ria?<\/h2>\n\n\n\n

El tractament de la periimplantitis \u00e9s un dels desafiaments m\u00e9s complexos de la implantologia contempor\u00e0nia, ja que la descontaminaci\u00f3 de la superf\u00edcie de l’implant \u00e9s m\u00e9s dif\u00edcil que la de la superf\u00edcie radicular d’una dent natural. El tractament no quir\u00fargic (desbridament mec\u00e0nic de la superf\u00edcie de l’implant mitjan\u00e7ant curetes espec\u00edfiques, ultrasons i sistemes de l\u00e0ser, combinat amb antibioter\u00e0pia local o sist\u00e8mica) pot controlar la inflamaci\u00f3 en casos de mucositis i periimplantitis lleu, per\u00f2 rarament aconsegueix la resoluci\u00f3 completa en els casos moderats i severs.<\/p>\n\n\n\n

El tractament quir\u00fargic \u00e9s necessari en la majoria dels casos de periimplantitis establerta: inclou l’acc\u00e9s quir\u00fargic al defecte ossi, la descontaminaci\u00f3 de la superf\u00edcie de l’implant sota visi\u00f3 directa (mitjan\u00e7ant instruments mec\u00e0nics amb glicina o eritritol, aplicaci\u00f3 de solucions antis\u00e8ptiques o l\u00e0ser) i, quan el defecte ossi t\u00e9 morfologia favorable, la regeneraci\u00f3 \u00f2ssia periimplant\u00e0ria amb membrana i material d’empelt per a intentar recuperar l’os perdut. Les taxes d’\u00e8xit del tractament quir\u00fargic de la periimplantitis s\u00f3n variables, amb una proporci\u00f3 significativa de casos que requereixen retretament o que en estadis molt avan\u00e7ats acaben amb la explantaci\u00f3 de l’implant afectat.<\/p>\n\n\n\n

Com es prev\u00e9 la p\u00e8rdua \u00f2ssia periimplant\u00e0ria?<\/h2>\n\n\n\n

La prevenci\u00f3 \u00e9s, amb difer\u00e8ncia, l’estrat\u00e8gia m\u00e9s efica\u00e7 i rendible enfront de la p\u00e8rdua \u00f2ssia periimplant\u00e0ria. Els seus pilars s\u00f3n. Una higiene oral domicili\u00e0ria rigorosa: el raspall interproximal, el fil dental espec\u00edfic per a implants i l’irrigador oral s\u00f3n eines imprescindibles per a eliminar la placa bacteriana en les zones de dif\u00edcil acc\u00e9s al voltant dels pilars prot\u00e8tics.<\/p>\n\n\n\n

El manteniment periimplantari professional: les revisions peri\u00f2diques (cada sis mesos en pacients de baix risc, cada tres o quatre mesos en pacients amb antecedents de periodontitis o periimplantitis tractada) permeten detectar els signes preco\u00e7os de malaltia periimplant\u00e0ria abans que es produeixi p\u00e8rdua \u00f2ssia irreversible. El control dels factors de risc sist\u00e8mics: aband\u00f3 del tabac, control gluc\u00e8mic en pacients diab\u00e8tics i gesti\u00f3 del bruxisme mitjan\u00e7ant f\u00e8rula de desc\u00e0rrega s\u00f3n mesures amb impacte demostrat sobre la longevitat dels implants. I el disseny prot\u00e8tic adequat: una pr\u00f2tesi amb un perfil d’emerg\u00e8ncia correcte, marges accessibles a la higiene i una distribuci\u00f3 equilibrada de les c\u00e0rregues oclusals redueix de manera significativa el risc de p\u00e8rdua \u00f2ssia d’origen mec\u00e0nic.<\/p>\n\n\n\n

Preguntes freq\u00fcents sobre p\u00e8rdua \u00f2ssia en implants<\/h2>\n\n\n\n

La p\u00e8rdua \u00f2ssia al voltant d’un implant \u00e9s reversible?<\/h3>\n\n\n\n

La p\u00e8rdua \u00f2ssia periimplant\u00e0ria establerta no es regenera de manera espont\u00e0nia. Amb tractament quir\u00fargic adequat i en defectes ossis de morfologia favorable (defectes en cr\u00e0ter amb parets \u00f2ssies preservades), \u00e9s possible obtenir un cert grau de regeneraci\u00f3 \u00f2ssia mitjan\u00e7ant t\u00e8cniques de regeneraci\u00f3 guiada. No obstant aix\u00f2, en defectes avan\u00e7ats amb p\u00e8rdua horitzontal extensa, la recuperaci\u00f3 completa de l’os perdut \u00e9s dif\u00edcil d’aconseguir, i l’objectiu terap\u00e8utic s’orienta cap a l’estabilitzaci\u00f3 de la p\u00e8rdua \u00f2ssia m\u00e9s que cap a la seva reversi\u00f3 completa.<\/p>\n\n\n\n

Quant dura un implant dental si hi ha p\u00e8rdua \u00f2ssia?<\/h3>\n\n\n\n

La longevitat d’un implant amb p\u00e8rdua \u00f2ssia periimplant\u00e0ria dep\u00e8n directament de la magnitud de la p\u00e8rdua, de la seva velocitat de progressi\u00f3 i de l’efic\u00e0cia del tractament aplicat. Un implant amb periimplantitis lleu diagnosticada i tractada preco\u00e7ment pot tenir una longevitat similar a la d’un implant sense complicacions. Un implant amb p\u00e8rdua \u00f2ssia severa no tractada pot perdre la seva estabilitat i requerir explantaci\u00f3 en pocs anys.<\/p>\n\n\n\n

Tinc m\u00e9s risc de periimplantitis si vaig tenir periodontitis?<\/h3>\n\n\n\n

S\u00ed. L’antecedent de periodontitis \u00e9s un dels factors de risc m\u00e9s consistentment documentats per al desenvolupament de periimplantitis. Els pacients amb periodontitis tractada que reben implants tenen un risc significativament major de desenvolupar p\u00e8rdua \u00f2ssia periimplant\u00e0ria que els pacients periodontalment sans, la qual cosa subratlla la import\u00e0ncia de mantenir el tractament periodontal de suport de manera activa fins i tot despr\u00e9s de la col\u00b7locaci\u00f3 dels implants.<\/p>\n\n\n\n

\u00c9s necessari fer radiografies de control encara que l’implant no faci mal?<\/h3>\n\n\n\n

S\u00ed, i \u00e9s un dels missatges m\u00e9s importants en implantologia preventiva. La periimplantitis \u00e9s sovint asimptom\u00e0tica en les seves fases inicials: l’implant no fa mal, no hi ha mobilitat i el pacient no percep cap problema. La p\u00e8rdua \u00f2ssia progressiva nom\u00e9s \u00e9s detectable mitjan\u00e7ant control radiol\u00f2gic peri\u00f2dic, la qual cosa fa imprescindible el seguiment radiol\u00f2gic encara que l’implant aparentment funcioni amb normalitat.<\/p>\n\n\n\n

Si tens implants i portes m\u00e9s d’un any sense una revisi\u00f3 professional, \u00e9s el moment de programar-la. La detecci\u00f3 preco\u00e7 de la periimplantitis marca la difer\u00e8ncia entre un tractament senzill i un complex.<\/p>\n","protected":false},"excerpt":{"rendered":"

La p\u00e8rdua \u00f2ssia en implants dentals \u00e9s una de les complicacions m\u00e9s freq\u00fcents i importants de la implantologia a llarg termini. Encara que els implants dentals tenen taxes de superviv\u00e8ncia superiors al 95% a deu anys en condicions \u00f2ptimes, la […]<\/p>\n","protected":false},"author":3,"featured_media":7431,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[18],"tags":[],"class_list":["post-7432","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-implantologia-2"],"yoast_head":"\nP\u00e8rdua \u00f2ssia en implants: causes, prevenci\u00f3 i tractament periimplantari - Cl\u00ednica Belodonte<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.belodonte.es\/perdida-osea-en-implantes-causas-prevencion-tratamiento-periimplantario\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"P\u00e8rdua \u00f2ssia en implants: causes, prevenci\u00f3 i tractament periimplantari - Cl\u00ednica Belodonte\" \/>\n<meta property=\"og:description\" content=\"La p\u00e8rdua \u00f2ssia en implants dentals \u00e9s una de les complicacions m\u00e9s freq\u00fcents i importants de la implantologia a llarg termini. 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