4.05.23 Iya_Surgical mgmt of peri-implantitis Flashcards
What are the direct vs. indirect ways to diagnose peri-implantitis?
Berglundh ‘18
Absent Longitudinal evidence:
1. PD> 6mm
2. Bone loss > 3mm
Longitudinal evidence:
1. BOP
2. Clinically visible inflammation
3. Increase PD
4. Progressing bone loss
What are the direct vs. indirect ways to diagnose peri-implantitis?
Berglundh ‘18
Absent Longitudinal evidence:
1. PD> 6mm
2. Bone loss > 3mm
Longitudinal evidence:
1. BOP
2. Clinically visible inflammation
3. Increase PD
4. Progressing bone loss
What are the etiologies of peri-implantitis?
Schwarz - 2017 World Workshop
Etiology:
* Poor plaque control
* History of periodontitis
* Excess cement
* Smoking?
* Diabetes x
* Iatrogenic factors ?
* Occlusal overload?
* Ti particles?
Why would nonsurgical therapy be initially used to treat peri-implantitis?
- To remove clinical signs of inflammation
(Schwarz 2010) - To remove plaque
Renvert ‘19 - Consensus report:
NST can help reduce bleeding and in some cases PD reduced by 1mm at most. In advanced cases, complete resolution is unlikely
How effective is surgical treatment of peri-implantitis?
Heitz-Mayfield
Full thickness + VR
Ti coated Gracey curettes
Gauzes soaked in saline
No resective or implantoplasty
- SSD reduction in PD, BoP, suppuration
- 47% of implant sites showed complete resolution of disease
- 92% of the sites showed stable crestal bone levels
What is the Schwarz classification for peri-implantitis defects?
1a: buccal dehiscence
1b: buccal dehiscence extending over halfway around implant circumferentially
1c: circumferential defect, but li plate intact
1d: circumferential defect, with both bu and li plates absent
1e: Infrabony circumferential defect
What is the Monje peri-implantitis defect classification?
Class I: Intraosseous
* Class Ia: Buccal dehiscence
* Class Ib: 2-3 wall defect
* Class Ic: Circumferential defect
Class II: Supracrestal / horizontal defect
Class III: Combined defect
* Class IIIa: Buccal dehiscence + horizontal loss
* Class IIIb: 2-3 wall defect + horizontal loss
* Class IIIc: Circumferential defect + horizontal loss
Severity (subclassification):
Grade S: Slight (3-4mm / < 25% length)
Grade M: Moderate (4-5mm / 25-50% length)
Grade A: Advanced (>6mm / 50% length)
Does a resective approach + implantoplasty offer increased implant survival?
Ravida and coworkers found the resective approach with or without implantoplasty rendered similar survival rates, 90% survival with implantoplasty
vs. 82% without implantoplasty
Although only 68 implants were included, it was concluded that a more relevant variable
to the survival of implants is the amount of bone loss just before treatment
Are membranes recommended when regenerating peri-implantitis defects?
Roos-Jansaker ‘14
Prospective, 5 yr fwup
G1: resorbable membrane + bone substitute
G2: bone substitute alone
Radiographic bone fill
was SSD compared
to baseline, but
NSSD in both groups.
Both procedures are
stable. Additional use
of resorbable membrane does
not improve outcome
Dr. Wang says: Only PTFE + a submerged approach will really work if you’re using a membrane.
Which studies examine the submerged approach for regenerating peri-implantitis defects?
Monje
Infrabony 2/3 wall defects
15 pts (screw-retained prosthesis, < 50% bone loss, crater-like defect lacking
buccal bone, 2mm of KM and non-smokers)
NST
* 6 wks later
* Cover screw placed for 2 wks
* Col membrane + autogenous +BioOss
Results:
* Resolution of PI 85%
* 66% of defects had a supra bony
component (implantoplasty +GBR)
* 33% 2/3 infra bony defects
* Mean PPD change=3.7mm
* Mean KM reduction= 0.6mm
* Mean MBL change=2.3mm
Wen (Wang group)
D: glycine powders, LDA (Tetracycline
250 mg)
* Augmentation: dPTFE, 60%FDBA
cortical 20% bovine bone, autogenous
bone
* Fixation screws
* Periosteal scoring
* Horizontal mattress suture
Re-enter at 8 months to remove the dPTFE
Should bone graft be included in submerged regeneration of peri-implantitis defects?
Renvert’ 17
* Peri-implant
bone defects
* Surgical debridement
(control group), or in
combination with a bone
substitute (Endobon®)
(test group) was
performed.
Results:
No SSD in PI, midbuccal
recession
42% BOP in test vs. 5% in
control
“Successful treatment outcome
for T was more predictable when
a composite therapeutic
endpoint was considered
Should bone graft be included in submerged regeneration of peri-implantitis defects?
Renvert’ 17
* Peri-implant
bone defects
* Surgical debridement
(control group), or in
combination with a bone
substitute (Endobon®)
(test group) was
performed.
Results:
No SSD in PI, midbuccal
recession
42% BOP in test vs. 5% in
control
“Successful treatment outcome
for T was more predictable when
a composite therapeutic
endpoint was considered
What are the various bone augmentation protocols for peri-implantitis defects?
Schwarz
1. Bone filler particles alone (autogenous bone, allogenic bone,
xenogeneic bone and alloplastic bone substitute materials
2. GBR (with the use of barrier membranes)
3. Clinical and radiographic outcomes for xenograft > autogenous
4. Xenograft show better clinical treatment outcomes
5. Xenograft with collagen barrier membrane > alloplasts alone (PD
and BOP reductions)
6. Adjunctive use of biologics? PRF, EMD with xenografts
Dr. Wang says: If using BioOss, mix at least 50-70% of allograft with the BioOss.
Full Dr. Wang regimen: Implantoplasty, Ti brush, lasers, Airflow, irrigation. Bone graft should be mixed to contain at least some allograft
What factors negatively affect the success of peri-implantitis treatment?
Schwarz
*Regarding Access and resective surgeries:
For the patients enrolled in regular post-treatment
supportive care, successful treatment (based on
similar definitions of success) was reported in 53% of
implants following access flap surgery and 33%-75%
of implants after resective treatment over a 2 to 5-
year period.
The following factors were shown to negatively
influence treatment outcomes:
1. initial bone loss > 7 mm,
2. probing depths > 8 mm
3. suppuration
4. postoperative presence of biofilm
5. smoking, and modified implant surface
What factors increase the risk for recurrence of disease after surgical therapy of peri-implantitis?
Carcuac ‘20
The factors that are associated with recurrence of PI after surgical treatment
1- reduced marginal bone level at 1 year after surgery,
2- modified when compared to non-modified surfaces with OR of 1.4 and 5.1 with
recurrence
3-a residual deep PD of at least 6mm, rendered an OR of 7.4
