Implant Complications, Peri-Implantitis and Treatment Flashcards by sophie rosen

BIOLOGY OF IMPLANT
Epithelial Attachment
(3)

2mm
Long junctional epithelium attached implant
Via basal lamina and hemidesmosomes

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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

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Supracrestal connective tissue attachment
for Implants
– mm

3-4

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Soft Tissue Assessment
(3)

Dimensions of the papilla
Probing
Dimensions of the buccal soft tissue

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Osseointegration vs PDL
(2)

Periodontal mechanoreceptors
Higher stress at the neck of the screw/implant

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PDL space ~
(2)

0.2mm
Sensory feedback

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Timed occlusal contacts
Teeth opposing teeth: – microns
Implant opposing teeth: – microns
Implant opposing implant: – microns

20
48
64

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Vascularity
(3)

Limited in peri-implant gingival mucosa
Sources are from alveolar bone and the connective tissue
Same inflammatory response to plaque

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Proximity limitations:
Vertical soft tissue limitations:
Tooth-tooth
Tooth-implant
Implant-implant

1mm 5mm
1.5mm 4.5mm
3mm 3.5mm

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NEW CLASSIFICATION
Peri-implant Diseases and Condition
(4)

Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant hard and soft tissue deficiencies

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Peri-implant mucositis
Prevalence:
–% of patients
–% of implants

79
50-90

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Peri-implant mucositis
(4)

Caused by plaque accumulation.
Presence of inflammation.
Reversible condition.
Precursor of peri-implantitis.

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Peri-implantitis
Prevalence:
–% of patients
–% of implants

20
10-56

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Peri-implantitis
(4)

Caused by plaque accumulation.
Presence of inflammation.
Loss of supporting bone.
Non-reversible condition.

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Peri-implant hard and soft tissue deficiencies
Contributing factors:
(6)

tooth loss, trauma, periodontitis, thin
soft tissue, lack of keratinized mucosa,
implant malposition, etc.

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The microbiome may be different
although the opportunistic
periodontal pathogens can be
identified in —
patients

peri-implantitis

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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

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