04 Complications Related to Implant-Supported Restorations P1

Question 1

What is the definition of peri-implant health?

Answer 1

1. absence of clinical signs of inflammation (ex: swelling, redness)
2. absence of bleeding/suppuration on gentle probing
3. no increase in probing depth compared to previous examinations
4. no bone loss

Question 2

What is the definition of peri-implant mucositis?

Answer 2

1. bleeding and/or suppuration on gentle probing
2. no bone loss

Question 3

What is the definition of peri-implantitis?

Answer 3

a plaque-associated pathological condition that occurs in tissues around dental implants

Characteristics:
1. bleeding and/or suppuration on gentle probing
2. increased probing depth compared to previous examinations
3. bone loss

Question 4

How can you diagnose peri-implantitis if you do not have previous examination data?

Answer 4

1. bleeding and/or suppuration on gentle probing
2. probing depths of ≥ 6 mm (subgingivally)
3. bone levels ≥ 3 mm apical of the most coronal portion of the intra-osseous part of the implant

Question 5

What is the difference in disease progression between periodontitis and peri- implantitis?

Answer 5

The progression of peri-implantitis is faster than that observed in periodontitis and occurs in a non-linear and accelerating pattern .

Due to micro-rough surface of implant, which is paradise for bacteria to stick to, difficult for us to clean, accelerated progression.

Question 6

What are the risk factors for peri-implantitis?

Answer 6

Patients with poor plaque control who do not attend regular maintenance therapy are at higher risk of developing peri-implantitis–

1. rough surface
2. uncontrolled diabetes,
3. plaque,
4. bad OH,
5. smoking.

The main risk factor is: history of severe periodontal disease.

• The difference between severe perio disease and others are the genetics .

Question 7

Clinically relevant fact: How far should we push the envelope?

Answer 7

• Advances in implant design/ implant topography/ macro- or micro- surface characteristics, have improved implant success/ survival.
• We can implement dental implants in most treatment plans and provide solutions to our patients that were not possible before.
• But how far should we go? Always use your judgement and avoid “acrobatics”.
• Use scientific evidence to select an implant solution and put the patient’s wellbeing first.
• Follow patients’ wishes up to a point to avoid failing spectacularly.
• If you have doubts or not feeling confident for the treatment you are about to provide, then probably it’s a good idea to avoid doing it.