Biologic and clinical rationale for second-stage surgery and maintenance.

Increased understanding of the biologic and functional demands of osseointegration procedures have enhanced predictability. Basic science and clinical research have added to our knowledge of the microbiologic, histologic, and functional requirements of what constitutes successful cases. It is evident that control of the microbial flora around abutments is vital in maintaining peri-implant health. It has also been shown that a potential pathogenic flora is more likely to occur in the partially edentulous patient. More predictable indicators of peri-implant disease must be established, as classic periodontal measurements do not correspond to the active disease state around implants. Second-stage surgery must create a peri-implant environment in which functional and biologic needs are met. The patient's esthetic and phonetic requirements must be fulfilled. Using procedures described in this article these standards can be achieved.