Diagnosis and Treatment of Peri-Implant Disease

Question 1

What are the three components of an implant?

Answer 1

Implant fixture
Abutment
Restoration

Question 2

Abutment screw

Answer 2

Secures the abutment to the fixture

Question 3

Prosthetic retention screw

Answer 3

Secures the prosthesis/restoration to the abutment

Question 4

Peri-implant infection diagnosis is based on what findings

Answer 4

Bleeding upon probing
Suppuration around the implant
PD around the implant
Mobility
Radiographic bone loss

Question 5

Peri-implantitis definition

Answer 5

Inflammatory reactions associated with loss of bone around the implant

Question 6

Peri-implant mucositis definition

Answer 6

A reversible inflammatory reaction in the soft tissues surrounding a functioning implant

Question 7

An ‘Ailing Implant’ falls under what disease?

Answer 7

Peri-implant mucositis

Question 8

Failing implant

Answer 8

Due to peri-implantitis

Progressive alveolar bone loss, pocket formation, and/or suppuration are present

Question 9

Failed implant

Answer 9

Due to peri-implantitis

Hopeless and nonfuncitonal implant requiring removal - may exhibit mobility and pain

Question 10

T/F - A failed implant can be saved

Answer 10

False - it’s done.

Question 11

How can you treat failing implants?

Answer 11

Resolve inflammation (debride plaque, improve OH, antibiotics)
Correct unfavorable soft tissue morphology (via flap surgery or gingivectomy)
Re-osseointegration - decontaminate implant surface with citric acid or tetracycling, then GBR

Question 12

Class I Peri-implantitis

Answer 12

Slight horizontal bone loss with minimal peri-implant defects

Question 13

Class II Peri-implantitis

Answer 13

Moderate horizontal bone loss with isolated vertical defects

Question 14

Class III Peri-implantitis

Answer 14

Moderate to advanced horizontal bone loss with broad, circular bony defects

Question 15

Class IV Peri-implantitis

Answer 15

Advanced horizontal bone loss with broad, circumferential vertical defects, as well as loss of the oral and/or vestibular bony walls

Question 16

Class I Peri-implantitis Treatment

Answer 16

Surgical reduction of pocket depth, thinning of the mucosal flaps, and apical repositioning of flaps at a bone edge level
Implant surface is cleaned and decontaminated
Implantoplasty is only performed if threads are exposed

Question 17

Class II Peri-implantitis Treatment

Answer 17

Similar to Class I, but repositioning is performed more apically, exposing more implant surface - thus requiring implantoplasty
If resorption has 3 or more walls, this defect is restored using classical GTR techniques
In cases where the defect involves 1-2 walls, osteoplasty or bone leveling is performed

Question 18

Class III or Class IV Peri-implantitis Treatment

Answer 18

The presence of vertical defects almost always requires the use of GTR techniques

Question 19

Human BMP-2 Action

Answer 19

Stimulation of bone formation via recombinant human bone morphogenic protein-2

Question 20

How do you treat failed implants?

Answer 20

1) Remove the implant
2) Remove the implant, regenerate bone (GBR), and place new implant
3) Remove implant from function, decontaminate it, then resubmerge it

Question 21

What ultimately determines the long-term success of implants?

Answer 21

Maintenance of the implant

Question 22

At home implant maintenance

Answer 22

Pts should clean them to the same extent as natural teeth

Brush 2x/day for 2 minutes

Question 23

Implant maintenance office visits

Answer 23

Every 3-6 months (6 months if good OH)
RMH
Probe
Assess soft tissues
Examine prosthesis
Occlusal exam
Eval stability
Remove any plaque or calculus