1.17.23 Jon Mazzocco - Etiology of Periimplant diseases

Question 1

What are the common etiologies of peri-implantitis?

Answer 1

Sarmiento 2016
Plaque (80%)
Non-plaque (20%) = residual cement, smoking, impacted food, poor placement, prosthetic factors, pathology, lack of hard/soft tissue

Question 2

What evidence is there for plaque causing most peri-implantitis?

Answer 2

Berglundh 2017 AAP Consensus
Poor plaque control and poor compliance = higher risk for peri-implantitis.
Anti-infective treatments help slow disease progression.

Question 3

What are the periodontal bacteria colonizers?

Answer 3

Marsh 2015
Early: Streptococci, gram +
Bridging: F. nucleatum
Late: Red complex and AA

Question 4

What bacteria start to become common in peri-implant disease?

Answer 4

Zheng 2015
Red complex (p. gingivalis, t. forsythia, t. denticola), and F. nucleatum

Question 5

What bacteria are unique to peri-implantitis (compared to periodontitis)?

Answer 5

Ghensi 2020
P. endodontalis and F. fastidiosum
These pathogens are present in large percentages in peri-implantitis lesions.
(This is in addition to the usual Red complex and F. nucleatum that is in periodontitis lesions).

Laufarie 2017: Similar compositions between periodontitis vs. peri-implantitis biofilms. But, peri-implantitis shows additional other pathogens: (Pseudomonas aeruginosa, candida albicans, enteric rods, S. aureus)

Question 6

What’s the importance of KTW around implants?

Answer 6

Wennstrom & Derks 2012:
Systematic review of 19 studies. Shows that inadequate KT has a higher plaque score. (but NSSD for PD or recessions)

Lin 2013: Systematic review of 11 studies.
Wide (>2mm) KTW has better PI, GI, recession, CAL).

Berglundh 2017 AAP Consensus: KTW is better for plaque removal and patient comfort. However, lack of KTW is not currently associated with peri-implantitis.

Question 7

How does implant position relate to peri-implantitis?

Answer 7

Monje 2016
Factors causing peri-implantitis: Too buccal, thin tissue, minimal KTW

Tomasi 2010: Multi-center RCT on immediate impmlants.
Every 1 mm implant buccal positioning = 0.22 mm of the buccal bone is positioned more apically.

Question 8

What studies discuss foreign bodies as an etiology of peri-implantitis?

Answer 8

Wilson 2015:
Biopsies of peri-implant lesions showed cement in 19/34 cases, and titanium in 7/34 cases.

van Velzen 2015:
Floss remnants were found around implant necks in patients with intensive oral hygiene but progressive peri-implantitis.