Implant complications, Periimplantitis and Treatment Flashcards
implant tissue is divided into:
soft and hard tissues
soft tissue compartment is called:
peri implant mucosa
the hard tissue compartment forms a contact relationship with:
the implant surface to secure stability
what are the functions of the peri implant tissues
- mucosa protects the underlying bone
- bone supports the implant
- therefore health of the peri implant mucosa is critical
describe the vascular supply in implants
- supraperiosteal blood vessels
- form capillaries to the CT papilla
- vascular plexus of the PDL
- lateral to the JE
- runs coronally and terminates in supraalveolar portion of free gingiva
- implants lack a PDL and PDL plexus
what is the location of the probe tip, distance from bony crest, probing depth, and bleeding of healthy gingiva
- coronal to apical cells of JE
- 1.1-1.2
- 0.7
- negative
what is the location of the probe tip, distance from bony crest, probing depth, and bleeding of implant
- apical to apical cells of JE
- 0.2
- 2
- positive
what is evaluated in dental implants
- presence of plaque and calculus
- clinical appearance of peri implant tissue
- radiographic appearance of implant and peri implant structures
- occlusal status, stability of prostheses and implants
- probing depths and presence of exudate and/or bleeding on probing
- patient comfort and function
successful and stable endosseous dental implants exhibit ___ mobility
no
if there is mobility: a _____ is recommended
radiographic evaluation
what is examined in the implant if there is mobility
- abutment retaining screw
- prosthetic abutment collar interface examined for looseness and breakage
what can occlusal overload cause
loosening of abutment screws, implant failure, and prosthetic failure
occlusion should be evaluated when?
at every maintenance appointment
what is the radiographic protocol for follow up after stable initial integration
variable
what is CBCT used for
- standard of care
- planning
- assessment
what are the peri implant diseases
peri implant mucositis and peri implantitis
what is peri implant mucositis
an inflammation of the peri implant soft tissues and is characterized by edema, change in color (red or red-blue), bleeding and/or purulence on probing, with PD of greater than or equal to 4mm, and no evidence of radiographic peri implant bone loss
what are the general risk indicators for peri implant mucositis
- cigarette smoking
- radiation therapy
- poorly controlled diabetes
cigarette smoking has been established as a risk factor for peri implant mucositis in:
3 years
what HBa1c makes diabetes a risk factor for peri implant mucositis and what happens
- greater than 10.1
- increased bleeding around implant
what are the major risk indicators for peri implant mucositis
- oral hygiene
- compliance/lack of compliance with supportive implant therapy
- material and surface characteristics of implant components
- accessibility of biofilm removal around implant supported prosthesis
- location of the implant margins
- dimensions of keratinized peri implant mucosa
- excess cement
prevalence of peri implant mucositis with plaque was:
62.6%
what is the standard of care for management of peri implant mucosistis
mechanical biofilm control
peri implant mucositis in patients that are not adhering to supportive implant therapy is as high as:
48%
patients that adhered to a strict maintenance protocol had a prevalence of peri implantitis in the range of:
20%
in partially edentulous patients a lack of adherence to SIT within the overall patient sample was associated with onset of peri implantitis with an odds ratio of:
5.92
what is considered in material and surface characteristics of implant components
- evidence on the effect of implant surface roughness peri implant mucositis is limited
- studies looking at highly machined implant abutments and bleeding on probing showed little difference
- there was no difference in BOP between titanium and zirconium abutments either
accessibility of biofilm removal around implant supported prosthesis plays an important role in:
the prevention and management of peri implant diseases
the location of the implant margins has an impact on:
inflammation with supragingival margins being associated with decreased inflammation
is grafting of keratinized mucosa necessary to maintain peri implant health
no
what is excess cement associated with
- clinical signs of peri implant mucositis
- higher prevalence of peri implant mucositis in patients with cemented prostheses compared to screw retained prostheses
what is peri implant mucositis
an inflammatory lesion of the peri implant mucosa in the absence of continuing marginal bone loss
what is peri implant mucositis caused by
a disruption of host microbe homeostasis at the implant mucosa interface
peri implant mucositis is a ____ condition at the _____
reversible; host biomarker level
what are the factors associated with peri implant mucositis
- biofilm accumulation
- smoking
what is an important preventive strategy for peri implant mucositis
regular supportive peri implant therapy
what is the tissue response to microbial challenge at the 3 week mark
inflammatory lesions in the gingiva and peri implant mucosa
- similar location, size and apical extension
what is the tissue response to microbial challenge at the 3 month observation
- similiar composition to 3 week observation but different apical extension
- peri implant mucosa extended further apically
what is peri implantitis
a more advanced inflammatory disease that exhibits deep probing depths (greater than or equal to 5mm), BOP, and/or purulence, and radiographic evidence of peri implant bone loss beyond that typically associated with remodeling during healing
peri implantitis is a ___ condition occurring in _______ chracterized by_______
pathological; tissues around dental implants; inflammation in the peri implant mucosa and progressive loss of supporting bone
what are the clincal findings in peri implantitis
- soft tissue inflammation
- BOP
- progressive bone loss as noted on the radiographs
determination of prevalence of peri implantitis is complicated by:
- methodology: diabetic vs non diabetic, compliance to maintenance, smoker vs non smoker
- definition of peri implantitis
- PD greater than or equal to 6mm, 2.5mm radiographic bone loss, BOP or suppuration
- number of exposed threads afer 1 year or longer of occlusal loading
- diversity of implant designs
the prevalence of peri implant diseases showed that _____ of peri implant tissues had some form of inflammatory response and a prevalence of peri implantitis from _____-
90%; 28-51%
patients with a hx of periodontitis exhibited ____ prevalence of peri implantitis vs ____ for those with a negative hx of periodontitis
38%;11%
smoking increases the chance of peri implantitis by____ and mucositis by_____
31.6 or 3.8
existing peri implant mucositis is a significant risk factor for development of:
peri implantitis
what is the average prevalence of peri implantitis
28-51%
what are the significant risk factors for peri implantitis
- hx of periodontitis
- poor OH
- residual cement
- smoking
- genetics
- diabetes
- occlusal overload
- residual PD of 5mm or greater with BOP
- peri implant mucositis
- existing peri implantitis
personal hygiene must begin at_____ and modified with _______
the time of implant placement; use of oral hygiene aids to clean the peri implant region
what do interproximal brushes do
penetrate up to 3mm into a ginvial sulcus and effectively clean a periimplant sulcus
what must be examined during the maintenance visit
- peri implant tissue margin
- implant body
- prosthetic abutment to implant collar connection and prosthesis
what should be used when treating a failing implant
- remove contaminated surface if present
- citric acid/EDTA/tetracyline
- ultrasonics
- topical tetracycline
- surgical repair if indicated
what is done in surgical repair of implant
- osseous grafting/GBR
- remove implant from function
- remove implant - more common now due to better explantation kits
at the histologic level compared to periodontitis sites peri implantitis sites have:
larger inflammatory lesions
surgical entry at peri implantitis sites often reveal a ______ pattern of bone loss
circumferential
data identifying smoking and diabetes as potential risk factors/indicators for peri implantitis are:
inconclusive
there is some limited evidence linking peri implantitis to other factors such as:
- the post restorative presence of submucosal cement
- lack of peri implant keratinized mucosa
- positioning of implants that make it difficult to perform oral hygiene and maintenance
evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a:
rare event
