Implant Complications, Peri-Implantitis and Treatment Flashcards
BIOLOGY OF IMPLANT
Epithelial Attachment
(3)
2mm
Long junctional epithelium attached implant
Via basal lamina and hemidesmosomes
BIOLOGY OF IMPLANT
Connective Tissue
(3)
Parallel, circular “cuff-like” fiber bundles
Seal with a space of a 20nm wide proteoglycan layer
1-1.5mm high
Supracrestal connective tissue attachment
for Implants
– mm
3-4
Soft Tissue Assessment
(3)
Dimensions of the papilla
Probing
Dimensions of the buccal soft tissue
Osseointegration vs PDL
(2)
Periodontal mechanoreceptors
Higher stress at the neck of the screw/implant
PDL space ~
(2)
0.2mm
Sensory feedback
Timed occlusal contacts
Teeth opposing teeth: – microns
Implant opposing teeth: – microns
Implant opposing implant: – microns
20
48
64
Vascularity
(3)
Limited in peri-implant gingival mucosa
Sources are from alveolar bone and the connective tissue
Same inflammatory response to plaque
Proximity limitations:
Vertical soft tissue limitations:
Tooth-tooth
Tooth-implant
Implant-implant
1mm 5mm
1.5mm 4.5mm
3mm 3.5mm
NEW CLASSIFICATION
Peri-implant Diseases and Condition
(4)
Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant hard and soft tissue deficiencies
Peri-implant mucositis
Prevalence:
–% of patients
–% of implants
79
50-90
Peri-implant mucositis
(4)
Caused by plaque accumulation.
Presence of inflammation.
Reversible condition.
Precursor of peri-implantitis.
Peri-implantitis
Prevalence:
–% of patients
–% of implants
20
10-56
Peri-implantitis
(4)
Caused by plaque accumulation.
Presence of inflammation.
Loss of supporting bone.
Non-reversible condition.
Peri-implant hard and soft tissue deficiencies
Contributing factors:
(6)
tooth loss, trauma, periodontitis, thin
soft tissue, lack of keratinized mucosa,
implant malposition, etc.
The microbiome may be different
although the opportunistic
periodontal pathogens can be
identified in —
patients
peri-implantitis
Stronger inflammatory response was
around
implants than teeth; need
longer time to complete reverse
peri-mucositis than gingivitis
Peri-implantitis contained larger
proportions of (2) than in periodontitis
neutrophil granulocytes
and osteoclasts
Peri-implantitis
risk factors/indicators
(7)
micromovement
Poor plaque control
Lack of regular
maintenance
Tissue quality: thin
phenotype, bone
deficiency
Iatrogenic factors:
malpositioning, poor
design of emergency
profile, inadequate
abutment/implant
seating
Excessive cement
Occlusal overload
Titanium particles:
implant corrosion,
Peri-implantitis risk
indicators/modifiers
(4)
History of
periodontal disease
Smoking
DM
Genetic factors/
systemic condition
Disease presentation
(4)
Inflammation:
redness, swelling
Pain
Suppuration
Bone loss
CLINICAL EXAMINATION
(3)
Peri-implant tissue
Occlusion and mobility
Plaque, probing depth, BOP, exudates
Peri-implant probing
CLINICAL EXAMINATION
Diagnostic Procedures
Variables in peri-implant probing:
- Probe Positioning
- Presence of Inflammation (BoP, Exudates)
Plastic or Metal?
Occlusal overload
(3)
Loosening of abutment screws
Implant failure
Prosthetic failure
Successful and stable
osseointegrated implants
exhibited NO —
mobility
Loose crown:
Loose abutment:
Loose implant body;
screw or cement has loosened/broken
abutment screw has loosened
Oh, no….
Loose crown:
Loose abutment:
Loose implant body;
then
Take a radiograph
May need to remove the crown/bridge to evaluate implant body directly
KERATINIZED TISSUE WIDTH
MUCOSA THICKNESS
INITIAL TISSUE THICKNESS
– mm
2
RADIOGRAPH
AT PLACEMENT
Peri-implant radiolucency
Bone level
Assessment
< — bone loss per year after the 1st-year loading Albrektson
< — bone loss starting after loading
0.2mm
2mm
TREATMENT MODALITIES
(4)
Mechanical
Debridement
Implant Surface
Decontamination
Anti-infective
Therapy
Surgical
Technique
Mechanical
Debridement
SCALERS MADE OF STAINLESS STEEL AND ULTRASONIC TIPS CAN ROUGHEN THE IMPLANT SURFACES CREATING SCARRING AND PITTING.
LOCAL DRUG-DELIVERY DEVICES
TETRACYCLINE-CONTAINING FIBERS/ DOXYCYCLINE-CONTAINING GEL/ MINOCYCLINE MICROSPHERES
Surgical
Technique
(2)
IMPLANTOPLASTY
RESECTIVE SURGERY
REGENERATIVE SURGERY
BONE GRAFT
SOFT TISSUE GRAFT
MAINTENANCE OF DENTAL IMPLANTS
Provide guidelines for …
Focus on both … around the
dental implant
Work as a team— patient are co-therapists in the
maintenance therapy
Prevent future complications by thorough (2)
maintaining the long term health
of the dental implant
hard and soft tissue stability
diagnosis
and treatment planning
— early signs of disease
— corrective interventions
Important clinical decisions must be reached
at several stages during treatment and
maintenance of implant patients
Detect
Plan
Establish useful set of clinical parameters to
evaluate dental implants
Components
(3)
Assessment of home care
Examination of peri-implant soft tissue
Radiographic examination
Examples of varying protocols are:
(3)
Initial placement: 3 months, 6 months, 12 months, every 2 years.
Initial placement: 6 months, 12 months, and every 2 years if no pathology present.
Initial placement: every 6 months if pathology present.
A thorough review of —
and modifications
— removal from implant/prosthesis surfaces
Appropriate use of —
Reevaluation of the present — with modification as dictated by the
clinical presentation
oral hygiene reinforcement
Deposit
antibiotics
maintenance interval
nterproximal brushes can effectively
penetrate up to — into a gingival
sulcus and may effectively clean a
peri-implant sulcus
3mm
Maintenance treatment should be customized
according to each patient’s systemic and local
risk factors.
Patients with history of periodontitis with
acceptable self-care: —recare interval
Patients with no systemic or local risk factors:
— recare interval
3-month
6 month
