02.01.23 Hoda_Management of periimplantitis

Question 1

What was the 2010 definition of success for peri-implantitis?

Answer 1

Araujo & Lindhe 2018
‘‘the criteria of success demand an average marginal bone loss of less than 1.5 mm during the first year after the insertion of the prosthesis and thereafter less than 0.2 mm annual bone loss.’’

Question 2

What is the updated (2018) definition of peri-implantitis?

Answer 2

Kolsland ‘18
Presence of perfuse bleeding.
+/- suppuration.
Deep PDs of ≥6 mm.
Bone loss of ≥ 3.0 mm beyond initial bone remodeling). (NOTE: Berglundh ‘18 says is it ≥2mm, but Kolsland says ≥3mm)

Question 3

What is the prevalence of peri-implantitis at the patient level? Implant level?

Answer 3

Mombelli
Patient level: 20%
Implant level: 10%

Derks & Tomasi 2015
Mucositis: 43%
Peri-implantitis: 22%

Question 4

What are the etiologies of peri-implantitis according to Sarmiento?

Answer 4

Sarmiento 2016 IJPRD
79%: bacterial plaque
9%: iatrogenic factors
6%: exogenous irritants
5%: absent KT
2%: extrinsic pathology

Question 5

What are the risk factors for peri-implantitis, according to Schwarz?

Answer 5

Schwarz 2018, JOP
1- Lack of proper oral hygiene (Bacterial plaque).
2-History of periodontitis.
3- Smoking : Inconclusive (conflicting evidence)
4- Diabetes: Inconclusive (conflicting evidence)
5- Lack of regular maintenance therapy (indicator)

Question 6

What are the peri-implantitis classifications of early, moderate, advanced (by Rosen)?

Answer 6

Rosen 2022 IJPRD
Early: PD ≥4mm, less than 25% bone loss
Moderate: PD ≥6mm, 25-50% bone loss
Advanced: PD ≥8mm, >50% bone loss

Subclasses:
* A: implant is placed in the middle of the ridge
* B: implant is placed too far buccally
* C: Implant placed too far lingually

Question 7

What are the peri-implantitis defect classifications by Schwarz?

Answer 7

Schwarz 2007
Class I: infrabony. Class II: suprabony.
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Class Ie 55.3%
Class Ib 15.8%
Class Ic 13.3%
Class Id 10.2%
Class Ia 5.4%

Question 8

How to prevent peri-implantitis?

Answer 8

Fu & Wang 2020, Periodontology 2000
Patient:
Eliminate active periodontal disease (Disease control)
Good oral hygiene
Regular maintenance visits
Smoking cessation
Control diabetes (if present)

Clinician:
Proper 3-D implant positioning
Prosthetically-driven implant placement
Guided implant placement (when possible)

Implant site:
Thick tissue phenotype (> 2mm)
Wide band of keratinized gingiva (> 2mm)
Absence of infection.

Implant design:
0.5-1mm smooth implant collar.
Moderately rough implant surface.
Use of platform switching whenever feasible.
Non-Metal implants.

Prosthesis:
Use of screw-retained prosthesis whenever possible.
Natural emergence profile (Convex, =< 30)
Light occlusal contacts.

Question 9

What is the EP DDS protocol for peri-implantitis defects by HL Wang 2019?

Answer 9

Wen (and HL Wang) 2019
Etiology
Primary wound closure
Debridement
Decontamination
Stability of the wound

Question 10

Describe the decision tree for peri-implantitis management by Mombelli & Lang.

Answer 10

Mombelli & Lang 1998
[Add full decision tree here]

Question 11

Describe the peri-implantitis decision tree by Sinjab

Answer 11

Sinjab 2018
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Question 12

What are the recommended methods to disinfect the peri-implantitis surface according to Monje?

Answer 12

Monje 2022
Mechanical: Metal curettes & US scalers are widely used, Plastic instruments efficacy is still unclear, in fact, plastic remnants are a concern
Air-powder abrasion: Current evidence in favor, biocompatible, less chances of modifying implant surface morphology, very efficient in surface decontamination
Implantoplasty: Safe & effective, (+ resective and regenerative therapy)
Chemical:
* Sterile Saline: Difficult to assess its effectiveness (+ chemical/pharmacological strategies)
* Citric acid: Good antimicrobial and detoxification properties, leaves minimal surface alterations, increases wettability = enhances the re-osseointegration
* H2O2: Biological plausibility, bactericidal agent (+ mechanical therapy)
* EDTA: limited evidence, good biocompatibility and enhances antimicrobial properties
* Phosphoric acid: limited data
* CHX: Not supported due to osteoblast cytotoxicity
Laser
* Erbium lasers: Er:YAG, as an alternative to mechanical debridement (no evidence to support superiority)
* Diode lasers: No evidence supporting its superiority yet
Photodynamic Short-term clinical benefits, reduced benefits when used with surgical procedures
Electrolytic Limited data, decontaminates the biofilm but not calculus (+ mechanical)
Pharmacological Favorable short-term results supports using locally delivered ABX (+mechanical/chemical methods)