Management of dental implants. Flashcards
Fiber orientation on implant v natural teeth
Teeth perpendicular attachment Implant parallel with no attachment to the implant -So PD will be deeper
What to monitor at Annual exam
Oral hygiene Inflammation Bleeding Suppuration Probe depth
Implant BOP and bone loss
Sensitivity of consistent BOP at
implants 60-100% for
progressive bone loss
Periimplant mucositis
A disease in which
the presence of inflammation is confined to
the mucosa surrounding a dental implant
with no signs of loss of supporting bone.
Perimplantitis
An inflammatory process
around an implant which includes both soft
tissue inflammation and loss of supporting
bone.
Classification of Periimplantitis
early
moderate
advanced
Early Peri-implantitis
PD ≥ 4 mm with bleeding and/or
suppuration and bone loss <25% of
implant length
Moderate peri-implantitis
PD ≥ 6 mm with bleeding
and/or suppuration and bone loss 25-
50% of implant length
Advanced Peri-implantitis
PD ≥ 8 mm with bleeding
and/or suppuration and bone loss >50%
of implant length
AAP Threshold for Periimplantitis
Radiographic bone loss ≥ 2
mm beyond normal crestal
remodeling
Peri-implant mucositis prevalence
30.7% of implants
63.4% of patients
Peri-implantitis prevalence
9.6% of implants
18.8% of patients
AAP recommended maintenance interval
6 month
Plastic instruments and implant cleaning
Majority of current evidence shows plastic
instruments are ineffective on implants
Priority = plaque removal
Types of implant complications
Prosthetic
spft tissue
hard tissue
Prosthetic complications
Screw fractures
Loose screws/cement
Phonetic masticatory or esthetic problems
growth following placement
Excess Cement
Excess cement found in 81% of implants with peri-implantitis Excess cement found in 0% of healthy controls 74% of cases returned to health following endoscopic cement removal
Ailing implant def
– Soft tissue complications only
Complications without bone loss
Can be non-responsive to therapy
Failing implant
Involves bone loss
Clinical signs without mobility
Failed Implant
Implant is clinically mobile
requires removal
Early v late failure
– Early: failure to integrate
– Late: failure to maintain integration
Soft Tissue Complications
Mucositis Enlargement Loose abutment Insufficient keratinized tissue
First step in solving peri implant mucositis
Start with oral hygeine
Nonsurgical tx for Peri implant mucositis
– Hand scalers – Ultrasonic – Subgingival irrigation – Superfloss
Do you need CHX for tx
No studies show no difference v OH alone
Mucogingival procedures
– Free soft tissue autograft – Subepithelial connective tissue graft – Acellular dermal matrix allograft AlloDerm® – Mucograft®
Goals of tx of peri implantitis
– Soft tissue health
– Surface decontamination
– Regeneration or resection
Bony defect regen sequence
– Removal of prosthesis
– Regeneration procedure with or without
submerging implant
Regen material for bony defects
– Similar to GBR
– Must involve implant decontamination
Surface decon of implant
Citric acid Tetracycline -both harmful to soft tissue Clindamycin preferred Chlorhexidine
Surface decon contact time
5 min then glycine powder air abrasion
Tx of Peri-Implantitis
Sequence
– Surface decontamination – Air powder abrasive / TCN / saline – EMD on implant surface – FDBA or Bio-Oss + PDGF – Absorbable collagen membrane – Connective tissue graft if lacking KT
Two categories for failure
– Bacterial: similar flora to chronic periodontitis – Biomechanical Poor bone quality Load transmission Parafunction Prosthetic superstructure
Methods of implant removal
Use of hand drivers Trephines Extraction forceps Fingers? Implant removal kit
Dental readiness and implants
Class I - healthy, integrated, restored Class II or III - ailing, requiring restoration, requiring maintenance Class III - failing or failed Record should be stamped on 603a
