Implant symposium - Maintenance Flashcards
1
Q
Describe the soft tissue anatomy of an implant
A
- implants have a soft tissue cuff these are similar to the gingivae
- they are not connected to the implant surface the same way teeth are and are less resistant to probing
- this in combo with the anatomical position may lead to deeper probing depths and bleeding in healthy sites
2
Q
What is the definition of peri-implant disease
A
- collective term
- inflammatory reaction of tissues surrounding osseointegrated implants encompassing two main entities - peri-implant mucositis and peri-implantitis
- there has been a causative relationship demonstrated between plaque and perimplant disease
3
Q
What are the 3 current theories proposed to explain the aetiopathogenesis of peri-implant disease
A
- pathogenic microbial plaque, the microbial biofilm associated with perimplant disease is generally dominated by gram negative anaerobic bacteria
- result of micromovement of the implant (seen in px who have good OH)
- compromise in host healing and adaption predisposes to perimplantitis - higher risk for those who smoke and previous HN cancers
- status of the tissue surrounding implant
- implant design
- degree of roughness allowing plaque accumulation
- excessive forces
4
Q
What are risk factors for peri-implant disease
A
- poor OH
- poor access for OH
- smoking
- history of perio disease
- poorly controlled diabetes
- occlusal forces
5
Q
What is peri-implant mucositis
A
- no bone loss
- bleeding, pus and inflammation around tissue
- not related to probing depths around implants
- reversible
- similar to gingivitis
Note: all implants lose some bone loss after placement and loading but it should stabilise and not be progressive
6
Q
How do we diagnose peri-implant mucositis
A
- inflammation of mucosa at implant area with no supporting bone
- detection of bleeding on probing through redness and swelling
- diagnostic criteria - no radiologic sign of CBL
- can progress to perimplantitis
7
Q
What is peri-implantitis
A
- crestal bone loss
- may be bleeding and pus on probing
- may be painful
- check the loading
- may be asymptomatic
- irreversible
- similar to periodontitis
- progression may be faster around implants due to physiological differences in connective tissue morphology
- microflore similar to teeth with perio
8
Q
What are signs and symptoms of peri-mucositis
A
- bleeding on probing/palpation
- erythema
- suppuration
- pain and tenderness and or fistula
- swelling
- increase in pocket depths
- no evidence of crestal bone loss
9
Q
Here is a table showing the the signs of disease and treatment regimens for peri-implant disease
A
10
Q
What is the prevention advise for peri-implantitis
A
- warn that implant is high maintenance restoration
- assess risk factors for periodontal disease
- px should be advised to stop smoking
- px should be advised of importance of OH
- periodontal tx should be completed and there should have been a sufficient period fo supportive therapy to confirm stability
11
Q
What are the post-op instructions after implace placement
A
- use CHX mouthwash after surgery
- soft toothbrush until healing takes place, the switch to normal toothbrush
- OHI
- interndental brushes & 360 flossing technique for effective cleaning
- superfloss - single tuffted brush
- smoking cessation advise
12
Q
What are signs and sympyoms of peri-implantitis
A
- signs of chronic inflammation - colour and texture change in gingival tissues
- BOP
- probing depths against baseline probing depths (at placement)
- suppuration
- mobility
- radiographic bone loss
13
Q
How should we monitor implants
A
- gentle probing pressure
- should have baseline pocket depths - generally expecting around 3mm
- look out for recession and implant thread exposure
- take depths from 4 points around the implant: M, D, B, P
14
Q
Why does suppuration occur
A
- suppuration occurs if colalgen is being destroyed and tissue necrosis is occuring
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15
Q
What is the tx of periimplant disease
A
- nonsurgical mechanical therapy
- disrupt biofilm
- carbon fibre or titanium instruments
- plastic inserts ultrasonics to minimise damage to the implant surface
- removal of plaque retentive factors e.g excess cement
- correction of prosthesis design
