Implant Maintain and Complications Flashcards
What are the success criteria for implant patients?
No mobility
No radiographic peri implantitis signs
BL <0.2mm after year 1
No pain or parasthesia
Aesthetic success
How does a dental implant compare with natural tooth?
Connection in tooth: PDL, bone, and cementum.
Connection in implant: Ankylosis
JE in tooth: HD, complex BL
JE in dental implant: HD and BL
Connective tissue: Tooth = 13 groups, implant = 2 groups
BOP is more reliable in natural tooth than implants
What is peri-implantitis caused by?
Systemic illness
Smoking
Alchohol
Occlusal problems
Iatrogenic
What causes peri-implant mucositis?
Residual cement
Poor oral hygiene
Poorly contoured restorations
How common is mucositis and peri-implantitis?
Mucositis = 48%
Peri-implantitis = 6 - 61%
How common is mucositis and peri-implantitis?
Mucositis = 48%, 63.4%
Peri-implantitis = 6 - 61%, 18.8%
What are the characteristics of peri-implantitis?
Pus formation
Plaque and PPD
Redness and BOP
Mucositis
PD > 5mm
Is peri-implantitis correlated with periodontitis?
21% correlation. Not significant.
Regular maintenance following implant placement reduced frequency of peri-implantitis to 14.3%
Why are there more complications in using implants?
Increase in number of implants placed and number of dentists placing implants.
Limited undergraduate exposure to implants
Need to learn from industry short run courses.
Placement using aggressive protocols in compromised sites
High success rates reported in the courses
What are the risk factors for complications when placing implants?
Infection
Tissue trauma
Occlusal overload
Iatrogenic
Smoking
Poor oral hygiene
History of periodontitis
Prosthesis design
Implant surface (rough has higher risk)
Bone overheating
Micromovement during healing
What iatrogenic risk factors increase risk of peri-implantitis?
Band of keratinised tissue <2mm
Polyglactin sutures (Vicryl)
Narrow implants <3.5mm
Poor placement
Operator skill (First 100 implants worst success rates)
What causes early implant complications?
Infection
What causes late implant complications?
Infection / Overload
What are the symptoms that differentiate peri-implantitis due to infection from that due to trauma?
Infection: Pain, BOP, pus, PD>7mm, High gingival index and plaque index, Granuloma
Trauma and infection: Pain in some trauma cases, mobility, and peri-implant radiolucency
What other complications can arise due to implants?
Aesthetics due to recession and gingival asymmetry
Pain
Parasthesia
Is there an association between success of implants and past periodontitis?
Yes, 96% compared to 90%.
How should peri-implant maintenance be done?
Assess: Colour, crater, texture, and keratinised tissue. Assess prosthesis type.
Identify: Probe around the implant (Very lightly 0.15 - 0.2N), check for pus, bleeding, and exudate.
Monitor: Diagnostic parameters.
Specialist referral
How can complications be treated?
If plaque/BOP -> Mechanical therapy (plaque removal)
If Pd 4 - 6mm -> Antiseptics (alcohol/listerine)
If Pd 6mm +/- pus -> AB-local/systemic
If Pd and pus -> Resective/regenerative
What instruments are used to clean plaque around instrument?
US with sleeve
Plastic teflon nylon coated instruments
Titanium and polishing paste
Air powder abrasive sprays
Rotating titanium brushes
What non-surgical therapies are used for peri-implantitis?
Debridement
Irrigation
Laser debridement
PDT
Local antimicrobials
Systemic ABs
What are the types of surgical therapy for peri-implantitis?
Resective (thick tissues fare better)
Regenerative (total defect fill/reintegration?)
Explantation (explantation SR drop)
Which treatment is best at reducing periodontal probing depth?
GBR > Access flap = Bone grafting > Resection
All methods are effective in increasing CAL gain.
How are implant surfaces decontaminated?
Curettes plastics Stainless steel
Saline/CHX
Lasers
Implantoplasty
Antimicrobials
How does surgical treatment compare to non-surgical treatment for decontaminating implant surfaces?
Non surgical treatment decreased PPD and CAL by 1mm
Short term reduction in inflammation
Surgical was better than non surgical (quality of decontamination)
Danger of microcracks with laser treatment
